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rvu formula

  1. #1
    Default rvu formula
    Medical Coding Books
    Does anyone know what the rvu formula is for reimbursement? (% for preop,%for intraop, %for post op)

  2. Default
    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 ‚ÄúSurgical Only‚ÄĚ at the rate of 84% of the global surgical
    package* for the surgical procedure.
    CIGNA provides reimbursement for Modifier 55 ‚ÄúPostoperative Management Only‚ÄĚ at the rate of 9% of
    the global surgical package* for the surgical procedure.
    CIGNA provides reimbursement for Modifier 56 ‚ÄúPreoperative Management Only‚ÄĚ 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

  3. #3
    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.

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