Wiki rvu formula

[Nat]

Does anyone know what the rvu formula is for reimbursement? (% for preop,%for intraop, %for post op)

 

[cleanclaims]

Do you have a particular carrier in mind? I work for CIGNA as a provider rep and here's what we pay:

CIGNA provides reimbursement for Modifier 54 “Surgical Only” at the rate of 84% of the global surgical
package* for the surgical procedure.
CIGNA provides reimbursement for Modifier 55 “Postoperative Management Only” at the rate of 9% of
the global surgical package* for the surgical procedure.
CIGNA provides reimbursement for Modifier 56 “Preoperative Management Only” at the rate of 7% of the
global surgical package* for the surgical procedure.

I have several USB drives full of info so if there is someone else you are interested in, I probably have it here on a drive and I'd be happy to send it to you.

Wendi, CPC

 

[Nat]

Thanks Wendi. I have Aetna, United Healthcare and MCR. BCBS states that it is incorrect coding even though they follow NCCI edits. They won't pay using modifier 54, 55 or 56.