Question how to find work RVUs that correlate with certain CPT codes

Mrsrpc

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In order to complete this formula: [(work RVU x work GPCI) + (PE RVU x PE GPCI) + (MP RVU x MP GPCI)] x CF = final payment. I need to find a value to insert for work RVU for certain CPT codes. I know it has to do with time spent on the procedure, but cannot find where to get the specific information re: work RVUs for a particular CPT anywhere. Can anyone help?
 

thomas7331

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RVUs can be found on the PFS (Physician Fee Schedule) section of the CMS web site. (You also don't need to go through the trouble of computing this entire formula as the site includes all of this and makes the calculation for you.)

You can look up the RVUs assigned to individual CPT codes using the search tool here: https://www.cms.gov/medicare/physician-fee-schedule/search

Or you can download the complete list here: https://www.cms.gov/Medicare/Medica...nt/PhysicianFeeSched/PFS-Relative-Value-Files
 

Mrsrpc

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RVUs can be found on the PFS (Physician Fee Schedule) section of the CMS web site. (You also don't need to go through the trouble of computing this entire formula as the site includes all of this and makes the calculation for you.)

You can look up the RVUs assigned to individual CPT codes using the search tool here: https://www.cms.gov/medicare/physician-fee-schedule/search

Or you can download the complete list here: https://www.cms.gov/Medicare/Medica...nt/PhysicianFeeSched/PFS-Relative-Value-Files
Hi Thomas, Thank you for your reply. The problem I have with that search tool is that is ONLY accepts HCPCS codes, not CPT codes. I only have CPT codes for this activity. I wondered by CMS would create the process for use with CPT and/or HCPCS codes, but only make a tool that accepts one of them. It doesn't make sense. I must be missing something... Any ideas?
 

Mrsrpc

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Hi there, you can use the look up tool for CPT codes. CPT codes are HCPCS Level I codes. What we call HCPCS codes are HCPCS Level II codes.
Thank you for clarifying. I'm used to medical device and pharmacy home care billing, not physician billing, so CPTs are new. I did get a result for one of our HCPCS Level 1 code (CPT), but another still reveals no results. It's a common procedure grouping, and I know there is a fee assigned for it, but the CMS tool comes up with nothing. I tried to attach a screen shot here, but it didn't work (server error).
 
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thomas7331

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Hi Thomas, Thank you for your reply. The problem I have with that search tool is that is ONLY accepts HCPCS codes, not CPT codes. I only have CPT codes for this activity. I wondered by CMS would create the process for use with CPT and/or HCPCS codes, but only make a tool that accepts one of them. It doesn't make sense. I must be missing something... Any ideas?

Thank you for clarifying. I'm used to medical device and pharmacy home care billing, not physician billing, so CPTs are new. I did get a result for one of our HCPCS Level 1 code (CPT), but another still reveals no results. It's a common procedure grouping, and I know there is a fee assigned for it, but the CMS tool comes up with nothing.

Work RVUs only apply to physician services. There is no physician work associated with devices, supplies, drugs, etc., so no work RVUs are assigned for those types of codes.

In addition, some codes are not paid under the physician fee schedule, but use other schedules, e.g. the clinical laboratory schedule, drug average sales price schedule, DMEPOS fee schedule, etc. There are other fee schedules available on the CMS site - you'll have to navigate to the area that applies to the type of service you're trying to price. Those services use different pricing methodologies that may or may not involve RVUs.
 

Mrsrpc

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Work RVUs only apply to physician services. There is no physician work associated with devices, supplies, drugs, etc., so no work RVUs are assigned for those types of codes.
Correct. That is why I'm new to using CPT codes, as I'd previously worked in medical device and home infusion pharmacy.
 

thomas7331

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Correct. That is why I'm new to using CPT codes, as I'd previously worked in medical device and home infusion pharmacy.
If you have specific codes you're having problems with, feel free to post them or send them to me and I can try to help. I'd also note that some CPT codes are designated as 'carrier priced' in which case CMS does not assign an RVU or price and leaves it up to each Medicare contractor to determine the payment rate. In addition, codes for services that are not covered by Medicare, such as consultations or preventive medicine CPT codes, will not have RVUs and non-Medicare payers that do cover those will assign their own values.
 

Mrsrpc

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If you have specific codes you're having problems with, feel free to post them or send them to me and I can try to help. I'd also note that some CPT codes are designated as 'carrier priced' in which case CMS does not assign an RVU or price and leaves it up to each Medicare contractor to determine the payment rate. In addition, codes for services that are not covered by Medicare, such as consultations or preventive medicine CPT codes, will not have RVUs and non-Medicare payers that do cover those will assign their own values.
Thank you, Thomas. I later learned that the code in question (43999) was too broad to have any RVUs associated with it, as you'd suggested. Thanks for all the help, everyone!
 
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