How to Calculate RVUs (Relative Value Units)?
What is RVUs and wRVUs?
RVU stands for Relative value unit. It is a cost or value assigned for each CPT and HCPCS code by CMS (Centre for Medicare and Medicaid) for providing a service. It has majorly three components, physician work, physician expenses and malpractice overhead. The values of cost of RVU is used for calculating the actual cost for a procedure in Facility and Non-facility setting. wRVU stand for work RVU, which remain constant for all the facilities across the different geographic location. Work RVU are mostly used for provider compensation modes. The final compensation is derived multiplying the total wRVU with the dollar conversion factor.You can get the whole list of RVUs values for CPT and HCPCS codes for Facility and Non-facility in the CMS website. Just visit the below link to download all the details related to RVUs for the particular year.
You can go ahead and find the RVU values for a particular CPT code in AAPC website. Just visit the below link to get the page for RVU calculator.
Read also: Coding tips for CPT code 93922 and 93923
Formula for Calculating RVUs
When all the values are collected, these need to be calculated by using formula’s to get the total pricing
Below is the detail formula for calculation.
Non-Facility Pricing Amount =[(Work RVU * Work GPCI) + (Non-Facility PE RVU * PE GPCI) +(MP RVU * MP GPCI)] * Conversion Factor (CF)
Facility Pricing Amount = [(Work RVU * Work GPCI) + (Facility PE RVU * PE GPCI) + (MP RVU * MP GPCI)] * Conversion Factor
OPPS Non-Facility Payment Amount = [(Work RVU * Work GPCI) + (OPPS Non-Facility PE RVU * PE GPCI) + (OPPS MP RVU * MP GPCI)] * Conversion Factor
OPPS Facility Payment Amount = [Work RVU * Work GPCI) + (OPPS Facility PE RVU * PE GPCI) + (OPPS MP RVU * MP GPCI)] * Conversion Factor
The downloaded files containing RVU values from CMS website include
- Relative Value Units for CPT and HCPCS codes in Facility and Non-facility settings.
- GPCI components for each carrier/locality;
- Anesthesia conversion factors;
- Locality/county crosswalks;
- Outpatient Prospective Payment System (OPPS)-based payment caps data
Benefit of RVUs values
RVU values help in find the total of the services provided by the physician or the hospital.
RVU cost or value help in assigning modifier to CPT code. For example, when two codes have NCCI edit, as per guidelines the low-cost RVU procedure code need to be appended with 59 or X modifiers to bypass the edits.