HOW TO USE THE RBRVS - Calculating CPT payment

CMS publishes RVUs for CPT codes in the Federal Register. To calculate the Medicare physician payment for a service, the RVUs for each of the three components of the Medicare RBRVS physician fee schedule are multiplied by their corresponding GPCIs to account for geographic differences in resource costs. The sum of these calculations is then multiplied by a dollar conversion factor. When determining payment, it is important to take into consideration all the mechanisms within the Medicare RBRVS physician fee schedule incorporated into the final payment for physician services. Please note that thirdparty payers other than Medicare may not use all of the elements of the RBRVS to determine physician payment. For example, they may use their own conversion factor or not factor in the GPCIs.

Example: Level 3 office visit for the evaluation and management of an established patient in Marco Island, Florida (“Rest of Florida”Medicare Locality).
[Remember that in order for the physician to code 99213, the appropriate history, physical examination, and medical decisionmaking must be documented.]

The following RVUs, GPCIs, and Medicare Conversion Factor are based on the information provided by CMS in the Federal Register on November 25, 2009.

CPT Code 99213               Location: Marco Island, Florida (“Rest of Florida”Medicare Locality)

Work RVUs                                                 0.97      Work GPCI 1.000
Non-Facility Practice Expense RVUs      0.80      Practice Expense GPCI 1.000
Professional Liability Insurance RVUs   0.05     Professional Liability Insurance GPCI 1.724