Understanding

A practical guide to understanding RVUs in coding and Medicare reimbursement.

RVUs are made up of 3 key factors:

example of RVU calculation:

When Do RVUs Apply to CPT Code Selection?

While RVUs do NOT dictate which CPT code to choose during patient encounters, they can influence code selection in certain situations, such as:

• 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.
  

• 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.