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Add CPT codes to calculate total RVUs and estimated revenue
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99214office visitinjectionG0438What are RVUs?
Relative Value Units (RVUs) are a measure of value used in Medicare reimbursement for physician services. Each CPT code has an assigned RVU value that reflects the resources required to perform that service.
Three Components of RVUs
Work RVUs
Physician time, effort, skill, and stress required to perform the service. The largest component of total RVUs.
Practice Expense
Overhead costs including staff, equipment, supplies, and facility expenses. Varies by setting (facility vs non-facility).
Malpractice RVUs
Professional liability insurance costs. Typically the smallest component, varies by specialty and risk level.
How Medicare Payment is Calculated
Payment = Total RVUs × Conversion Factor × GPCI
Total RVUs: Sum of Work + Practice Expense + Malpractice RVUs
Conversion Factor (2026): $32.35 per RVU (national average)
GPCI: Geographic Practice Cost Index (0.85 to 1.15 typical range)
Common Use Cases
- Physician Productivity Tracking: Measure work effort independent of coding mix or payer rates
- Practice Management: Analyze productivity by provider, specialty, or service line
- Compensation Planning: Many practices pay physicians based on wRVU targets (e.g., $50-75 per wRVU)
- Financial Forecasting: Estimate revenue from service volume and RVU values
- Capacity Planning: Calculate total RVUs per day to assess clinical workload
Important Notes
RVU values are updated annually
CMS reviews and adjusts RVU values each year based on changing practice costs, new procedures, and resource utilization. Always verify current values for billing and compensation purposes.
Example Calculations
Primary Care Typical Half Day
3× 99214 (Established patient, moderate complexity)
2× 99213 (Established patient, low complexity)
1× 99215 (Established patient, high complexity)
Work RVUs: (3 × 1.5) + (2 × 0.97) + (1 × 2.11) = 8.55 wRVU
Total RVUs: 12.20 RVU
Est. Revenue: ~$395
Cardiology Consultation + Procedures
1× 99204 (New patient, moderate complexity)
1× 93000 (Electrocardiogram, complete)
1× 93306 (Echocardiography, complete)
Work RVUs: 2.6 + 0.17 + 1.35 = 4.12 wRVU
Total RVUs: 5.83 RVU
Est. Revenue: ~$189
Preventive Annual Wellness Visit (Medicare)
1× G0439 (Annual Wellness Visit, subsequent)
1× G0444 (Depression screening, PHQ-9)
Work RVUs: 1.5 + 0.18 = 1.68 wRVU
Total RVUs: 2.38 RVU
Est. Revenue: ~$77
Note: Revenue estimates use the national average conversion factor ($32.35 for 2026) and do not include geographic adjustments or payer-specific rates. Actual reimbursement varies by location and insurance contract.
Frequently Asked Questions
RVUs are standardized units that represent the relative complexity and resources required for a medical procedure. One RVU = work performed + practice expense + malpractice insurance. Medicare multiplies total RVUs by the conversion factor ($32.35 in 2026) to determine payment.
The 2026 Medicare conversion factor is $32.35 per RVU. This converts relative value units into actual dollar payments. CMS updates this annually in December based on legislative caps.
1) Enter the CPT code. 2) The calculator shows work RVUs, practice expense RVUs, and malpractice RVUs. 3) Add all RVUs together. 4) Multiply total RVUs by the conversion factor ($32.35 in 2026). Result = estimated Medicare payment.
Work RVU = physician time, skill, and effort (about 52% of payment). Practice Expense RVU = cost of equipment, staff, supplies (about 45% of payment). Malpractice RVU = insurance cost (about 3% of payment).
This calculator uses the official CMS Medicare Physician Fee Schedule. It's accurate for estimating Medicare payments. Actual reimbursement varies by: geographic location, carrier, and specialty. Use this as a reference, not final billing guidance.
No. Commercial insurance uses different fee schedules. This calculator is Medicare-specific. Your contracted rates with Aetna, UnitedHealth, etc. are usually different from Medicare.
GPCI adjusts Medicare payments based on geographic location. Some areas have higher practice costs (labor, rent, malpractice). CMS applies these adjustments to the conversion factor automatically.
Yes. CMS reviews and adjusts RVU values each January based on the Medicare Physician Fee Schedule. The conversion factor is updated in December. Always verify current values with official CMS sources.
Use total RVUs per physician per day to measure productivity. Track this over time to identify trends. Compare across specialties using benchmarks from MGMA, AMSSM, or specialty societies.
Modifiers change how codes are paid. For example, -25 allows separate E/M billing. -50 is bilateral (both sides). Check with your billing team or coding compliance officer about modifier-specific RVU adjustments.
Related Resources
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