• If this is your first visit, be sure to check out the FAQ & read the forum rules. To view all forums, post or create a new thread, you must be an AAPC Member. If you are a member and have already registered for member area and forum access, you can log in by clicking here. If you've forgotten the password it can be reset on our sign in section by entering your registered Email Address or Username here. To start viewing messages, select the forum that you want to visit from the selection below..

Wiki rvu formula

Create Wiki
N

Nat

Guest
Messages
22
Best answers
0
Does anyone know what the rvu formula is for reimbursement? (% for preop,%for intraop, %for post op)
 
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
 
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.
 
You must log in or register to reply here.
Top