Wiki Specialty taxonomy affect on RVU

[dawnsouthard]

I am trying to ensure my provider is reimbursed appropriately per his specialities. In my research I found:

• Specialty-based RVUs:
  Different medical specialties have different RVUs assigned to the same procedure, meaning a provider's taxonomy-determined specialty can affect their reimbursement for a given service.
  So----how do I find the RVUs assigned for a specific taxonomy? When searching the cms provider fee schedule I do not see any option to indicate a specific taxonomy. Anyone with any knowledge please help
  

 

[sls314]

I am trying to ensure my provider is reimbursed appropriately per his specialities. In my research I found:

• Specialty-based RVUs:
  Different medical specialties have different RVUs assigned to the same procedure, meaning a provider's taxonomy-determined specialty can affect their reimbursement for a given service.
  So----how do I find the RVUs assigned for a specific taxonomy? When searching the cms provider fee schedule I do not see any option to indicate a specific taxonomy. Anyone with any knowledge please help

RVU values for a procedure are the same, regardless of the provider's specialty.

You can find the detailed RVU files and methodology on the CMS website: https://www.cms.gov/medicare/payment/fee-schedules/physician/pfs-relative-value-files

Edit to add: The RVU benchmarks for a specialist may be higher than for a primary physician, because the specialist may be providing a MIX of higher RVU services than the primary physician. However, for each specific CPT code, the RVU value is the same regardless of taxonomy.

 

[csperoni]

The RVUs do not change based on specialty. There can be variances for office vs facility, or for geographic adjustments.
I will note that a contract with a carrier may specify different fee schedules based on specialty. For example, your contract with a payor could state GI is reimbursed at $$$ per RVU and neurology at $$$ per RVU, and obgyn at $$$ per RVU. Each type of specialist would receive slightly different reimbursement if each billed 99214. Large multispecialty provider groups often negotiate contracts this way. Perhaps you are confusing this with RVU values.

 

[amyjph]

It's the provider or group contracts you need to be looking at.