CPT RVU Calculator
Calculate Medicare Reimbursement and Relative Value Units for Physician Services
Base RVU Values
Geographic Adjustments (GPCI)
Understanding CPT RVUs and Physician Reimbursement
In the United States medical billing system, Relative Value Units (RVUs) are the standard metric used by Medicare and private insurers to determine how much a physician should be paid for specific medical services. These services are identified by Current Procedural Terminology (CPT) codes.
The Three Components of an RVU
Every CPT code has three distinct RVU components that reflect different costs associated with providing care:
- Work RVU (wRVU): Accounts for the physician's time, skill, mental effort, and technical expertise. This is often used internally by hospitals to calculate productivity bonuses.
- Practice Expense RVU (peRVU): Accounts for the overhead costs of the practice, including clinical staff salaries, rent, medical supplies, and equipment.
- Malpractice RVU (mpRVU): Accounts for the cost of professional liability insurance premiums.
The Calculation Formula
The formula for calculating the total Medicare allowable payment for a specific CPT code is as follows:
Total Payment = Total RVU × Conversion Factor
What is GPCI?
The Geographic Practice Cost Index (GPCI) is a multiplier used to adjust reimbursement based on the location of the practice. Since it costs more to run a practice in Manhattan than in rural Mississippi, the GPCI ensures that payments reflect local economic conditions. There are separate GPCI values for Work, Practice Expense, and Malpractice for every Medicare locality.
Example Calculation
Imagine a common office visit (CPT 99213) with the following values:
| Component | Value | GPCI (Local) | Subtotal |
|---|---|---|---|
| Work | 0.97 | 1.00 | 0.97 |
| Practice Expense | 1.02 | 1.10 | 1.122 |
| Malpractice | 0.07 | 0.85 | 0.0595 |
| Total RVUs | 2.1515 | ||
If the Conversion Factor is $33.2875, the payment would be: 2.1515 × 33.2875 = $71.62.