UCR

Usual and customary reductions (UCR's) are a cost containment mechanism used by the insurance industry to regulate the amount paid to health care providers.  The usual and customary rate is normally associated with the statistical average charge for a CPT code in a given area.  Managed care contracts as well as state and federal programs usually require that health care providers accept a percentage of the UCR for the area where services were provided.

The Florida No Fault Act (also known as the PIP Statute) requires that PIP Insurers pay 80% of the charges for reasonable and necessary medical care.  There is nothing in the PIP Statute which allows PIP Insurers to reduce charges due to UCR reductions.  Since insurers control the data used to establish the UCR's and will not provide the medical community with this data we question whether you should accept these reductions.