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Looking for a way to get a handle on Relative Value Units (RVUs) tied to Medicare payments or even use of RVUs in your own practice? Here's the formula Medicare uses to calculate payments for the services you provide.
Tool updated with CY 2015 Medicare Physician Fee Schedule data / downloads
Looking for a way to get a handle on Relative Value Units (RVUs) tied to Medicare payments or even use of RVUs in your own practice? Here's the formula Medicare uses to calculate payments for the services you provide*:
[(Work RVUs x Work GPCI) + (Practice Expense RVUs x Practice Expense GPCI) +
(Malpractice RVUs x Malpractice GPCI)] = Total RVU
Total RVU x Conversion Factor = Medicare Allowable Payment
Now what does this all mean? Good question.
First, let's get the data you'll need.
For the red data, the RVUS, you'll need to go to CMS' website and download the 2015 RVU data, compiled in a zip file. Please note that you'll have to agree to proper use of CPT codes, which are a copyright of the AMA.
Once you download the data, open the file titled "PPR15_V1223.xlsx." This is a Microsoft Excel document. A list of CPT codes runs down Column A and to the right is the RVU data you'll need:
Work RVUs - Column F
Practice Expense (PE) RVUs – Column I
Malpractice RVUs – Column K
Conversion Factor – Column Y
Now the blue data. In the zip file, open CY2015_GCPIs.xlsx, another Excel file.
This one's a bit easier to use. Find your location and then look to the right to find:
Work GPCI – Column D
Practice Expense GPCI – Column E
Malpractice GPCI – Column F
You now have everything you need to calculate Medicare payments, based on RVUs, for the whole series of CPT codes.
*Physicians Practice would love to simply provide you with a tool to calculate your expected payment for the services you perform, based on any CPT code that you select. But we've been stymied in this effort by the AMA, which holds the copyright to the CPT codes themselves. To publish such a calculator, we must first acquire a license from the AMA and charge you $13.50 each time you access the calculator. Since CPT codes are a copyright of the AMA, the association and expects to be paid by those physicians (and others) who seek to use the codes to understand how they are being paid.
Here are a couple of resources you can use to move a little more quickly through the process:
• The AMA does provide its own CPT search / RVU calculator, but again, you must agree to use the codes properly.
• Our friends at PedSource / Physician's Computer Company have provided an Excel template for you to build your own RVU Calculator using the data above. If you plan on calculating a lot of RVU data, this would be a good place to start.