Relative Value Units (RVU) Calculator
If you’re studying for your CPC or CPB exam, you really won’t need to worry about RVU’s or the formulas and calculations.
Relative Value Units (RVUs) are used by Medicare and other payers to determine physician reimbursement for medical services based on the Resource-Based Relative Value Scale (RBRVS).
RVUs are made up of three key factors:
1. Work RVU (wRVU) → Physician effort, time, skill, and judgment
Generally Stay the Same
Work RVUs reflect the time, skill, and effort required for a particular medical service, and these values typically do not vary by region.
They are standardized across the country for a given CPT code.
They represent the intensity of the physician’s effort for that procedure or service.
2. Practice Expense RVU (PE RVU) → Cost of equipment, supplies, and overhead
Vary by Region
PE RVUs reflect the costs of running a medical practice, including overhead costs like rent, equipment, administrative staff, and supplies.
These values do vary by region based on local market conditions and regional cost differences.
The Geographic Practice Cost Index (GPCI) adjusts these values for each geographic area to reflect differences in the cost of living and practice expenses.
3. Malpractice RVU (MP RVU) → Cost of liability insurance
Vary by Region
MP RVUs reflect the cost of malpractice insurance for a specific type of service or procedure.
These values also vary by region because malpractice insurance costs can differ significantly across different states or local areas.
Areas with higher malpractice insurance premiums will have higher MP RVUs.
Conversion Factor (CF) is a dollar amount set by CMS that changes annually.
GPCI (Geographic Practice Cost Index) adjusts for regional cost differences.
Medicare reimbursement is calculated using this formula:
Total RVU = (wRVU x Work GPCI) + (PE RVU x PE GPCI) + (MP RVU x MP GPCI)
Then, to determine payment:
Medicare Payment = Total RVU x Conversion Factor (CF)
Let’s take CPT code 99213 (Established Patient Office Visit) for example:
Work RVU = 0.97
PE RVU = 1.00
MP RVU = 0.07
Conversion Factor (CF) = $33.89 (per 2025)
GPCI values: Work = 1.0, PE = 1.2, MP = 0.9
Calculate TOTAL RVU:
(0.97 x 1.0) + (1.00 x 1.2) = (0.07 x 0.9)
= 0.97 + 1.20 + 0.063 = 2.233 (Total RVU)
Calculate Medicare Payment:
2.233 x 33.89 = $75.69
Medicare would reimburse $75.69 for this service.
*AAPC has a (work) RVU calculator that I use to to identify wRVU for codes and note it in my CPT book. To use this AAPC wRVU calculator, see the calculator below or click here to be directed to AAPC’s RVU calculator website.
When do RVUs apply to CPT code selection?
While RVUs don’t dictate which CPT code to choose during patient encounters, they can influence code selection in certain situations, such as:
Choosing Higher Complexity Codes:
Providers might choose a higher-level CPT code (e.g., from a range of office visits) if the service provided involved more complexity, time, and effort. These codes tend to have higher work RVUs, which translate to higher reimbursement.Avoiding Under- or Over-Reporting Services:
If a physician consistently selects a lower RVU code for a service that requires more time or work (e.g., choosing a 99212 when a 99213 would be appropriate), they may not be properly reimbursed for the work performed. Conversely, selecting a code with too high an RVU (for services not rendered) could lead to overbilling.Selecting Add-on Codes for Multiple Services:
RVUs can also affect the choice of add-on codes (e.g., +17315 for additional tissue blocks in Mohs surgery). Providers should be aware of RVU values for add-on codes to ensure proper reimbursement.Multiple Procedures in a Single Encounter:
If several procedures are performed on the same patient during the same session, the one with the highest RVU may be the most complex or resource-intensive procedure, and it often becomes the primary procedure.
Example:
If a patient undergoes a surgical excision (high RVU) and a biopsy (lower RVU), the excision would generally be coded as the primary procedure.Multiple Surgical or Diagnostic Procedures:
When multiple surgeries or procedures are performed, RVU values can help determine which one to list first, especially if the procedures are unrelated or occur in different body areas.
AAPC has a (work) RVU calculator that I use to to identify wRVU for codes and note it in my CPT book. To use this AAPC wRVU calculator, see the calculator below or click here to be directed to AAPC’s RVU calculator website.
