Common:
More options (provider category, injury date, multiple procedures, 2019 charges)
Therapy codes have their own Medicare reduction on additional units, applied to part of the payment only; if you want it reflected, type the reduced amount into the line. Built-in amounts: CMS Medicare Physician Fee Schedule, 2026, Michigan (MAC 08202), non-QPP rates; data updated Oct. 1, 2026. For services in another year, type the Medicare amount from the CMS look-up.
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| Code | Units | Basis | Ceiling per unit | Line ceiling |
|---|
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Example values shown; replace them with yours. Nothing you enter leaves your browser unless you send it with a request; patient names are never needed here. This is an illustration of the statutory ceiling under MCL 500.3157 only. A payment below the ceiling does not by itself mean more is due.
Before you rely on a figure
- The date of service sets the percentage. The fee schedule covers treatment rendered after July 1, 2021 (MCL 500.3157(14)).
- The provider category must be one you actually qualify for. The higher categories depend on indigent volume measured on July 1 of the year of treatment, a DIFS designation, or trauma-center verification.
- The percentage applies to the amount payable under Medicare for the service. If Medicare pays no amount, the percentage of your January 1, 2019 charge under subsection (7) applies instead.
- Under Andary v USAA (Mich. 2023), the fee schedule does not apply to a patient injured, while covered by a policy issued, before June 11, 2019.
- Ambulance emergency services are excluded (subsection (13)), and no figure here decides whether a charge was reasonable, or whether care was necessary or related to the crash.
How the ceiling is calculated
| Category (% of Medicare) | July 2, 2021–July 1, 2022 | July 2, 2022–July 1, 2023 | After July 1, 2023 |
|---|---|---|---|
| Most providers, MCL 500.3157(2) | 200% | 195% | 190% |
| 20–30% indigent volume or designated rehab facility, (3) | 230% | 225% | 220% |
| 30% or more indigent volume, (5) | 250% | 250% | 250% |
| Level I/II trauma center, emergency care before stabilization, (6) | 240% | 235% | 230% |
When Medicare provides no amount for a service, MCL 500.3157(7) uses a percentage of the provider’s charge description master in effect on January 1, 2019 (or its average charge that day), adjusted each year under subsection (9):
| Category (% of Jan. 1, 2019 charge) | July 2, 2021–July 1, 2022 | July 2, 2022–July 1, 2023 | After July 1, 2023 |
|---|---|---|---|
| Most providers, (7)(a) | 55% | 54% | 52.5% |
| 20–30% indigent volume or designated rehab facility, (7)(b) | 70% | 68% | 66.5% |
| 30% or more indigent volume, (7)(c) | 78% | 78% | 78% |
| Level I/II trauma center, emergency care before stabilization, (7)(d) | 75% | 73% | 71% |
Percentages apply to the amount Medicare would pay for the same service, in the locality where it was rendered, under the fee schedule in effect on the date of service. Under MCL 500.3157(8), the Medicare-based amount can never exceed the provider’s average charge for that service on January 1, 2019, as adjusted annually for medical inflation under subsection (9). If you leave that charge blank, the calculator labels the result a limited estimate.
The ceiling is the most a provider is eligible to be paid. Whether an insurer owes more on a given bill also depends on whether the charge was reasonable and the care was reasonably necessary and related to the crash. When benefits are overdue, interest can apply; see interest and attorney fees.
Sources: MCL 500.3157(1) to (9), (13) and (14); Andary v USAA (Mich. 2023).
A case in focus
Paid $64 a test. Settled at $2,500 or more
- The problem
- A provider performed detailed range-of-motion testing of the neck, back and arms and legs, producing pages of objective findings for each patient. Insurers routinely paid about $64 per test.
- What the firm did
- Filed suit on the provider’s underpaid claims. Worked with a medical coding and billing expert to confirm the codes billed were correct and to calculate what the no-fault fee schedule actually required for the test.
- The evidence that mattered
- The coding expert’s review and the fee-schedule calculation: $2,537.50 owed per test, not $64.
- Outcome
- Settlements of $2,500 or more in almost all of the provider’s cases. None went to trial.
- Keep in mind
- These are per-test amounts across a series of one provider’s claims. What is owed depends on the service, the codes billed and the fee schedule that applies.
Read Justin’s account of this case
Details that could identify the client are left out. Every matter turns on its own facts; this does not predict the result in another case. Amounts are gross, before fees, costs and liens.
Questions people ask us
Does the fee schedule apply to every Michigan auto claim?
It applies to treatment rendered after July 1, 2021. The Michigan Supreme Court held in Andary v. USAA (2023) that it does not apply to people who were injured, while covered by a policy issued, before June 11, 2019.
What if Medicare has no amount payable for the service?
Then MCL 500.3157(7) applies instead: a percentage of the provider’s charge for the service on January 1, 2019, adjusted each year for medical inflation under subsection (9). For services after July 1, 2023 that is 52.5% for most providers. Choose “No” for the Medicare question and enter the adjusted 2019 charge.
Who qualifies for the higher percentages?
Providers with 20% or more indigent volume that DIFS certifies, up to two designated freestanding rehabilitation facilities, and Level I or II trauma centers for emergency treatment before the patient is stabilized and transferred.
