RVU look-up tables: Free tools from CMS

By Marti Cox, MLIS
April 14, 2016
Body of Knowledge Domain(s): Financial Management

Members often contact the Knowledge Center to find the corresponding work relative value unit (RVU) for a particular CPT® or HCPCS® code.

These RVU amounts are presented in the annual Medicare Physician Fee Schedule, but complete information on the annual update is also presented in great detail in the Physician Fee Schedule section on the Centers for Medicare & Medicaid (CMS) website.

To find specific RVU information, note these key resources:

PFS Look-up Tool (quick reference for one or a few codes)

This tool, an interactive section of the CMS website, is extremely easy to use, simplifying access to RVU values using data from the Physician Fee Schedule. It allows you to:

  • Search pricing amounts, various payment policy indicators, RVUs, and GPCIs by either a single procedure code, a range, or a list of procedure codes; and
  • Search for the national payment amount, a specific Medicare Administrative Contractor (MAC) or a specific MAC locality.
    The tool takes you through the selection steps prior to the display of the information – all explained in the downloadable guide “How to Use the Searchable Medicare Physician Fee Schedule (MPFS).”

PFS Relative Value Files (full data files for research and analysis)

For those requiring the entire set of fee schedule data, the current year’s files and periodic updates are posted on this page throughout the year.  For historical comparisons, this page also contains links to RVU files going back to 2003.

A downloadable ZIP file for each update contains information on more than 10,000 physician services, the associated RVUs, a fee schedule status indicator, and various payment policy indicators needed for payment adjustment (i.e., payment of assistant at surgery, team surgery, bilateral surgery, etc.).

The Medicare physician fee schedule amounts are adjusted to reflect the variation in practice costs from area to area. A geographic practice cost index (GPCI) has been established for every Medicare payment locality for each of the three components of a procedure’s relative value unit (i.e., the RVUs for work, practice expense and malpractice).

The GPCIs are applied in the calculation of a fee schedule payment amount by multiplying the RVU for each component times the GPCI for that component.

Specific files contained in the ZIP download, include:

  • Relative Value Units (corresponding values and components are shown for each procedure code)
  • GPCI components for each carrier/locality;
  • Anesthesia conversion factors;
  • Locality/county crosswalks;
  • Outpatient Prospective Payment System (OPPS)-based payment caps data; and
  • “Read-me” files with complete instructions for RVU calculations

You can find an in-depth explanation and instruction on RVU analysis in RVU's: Applications for Medical Practice Success, 3rd Edition

If you’d like assistance navigating these resources, contact the Knowledge Center staff.

Marti Cox, MLIS, knowledge center advisor, MGMA

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