1. What is the CPT Code Fee Calculator?

The CPT Code Fee Calculator determines the payment amount for medical procedures based on Relative Value Units (RVUs) and a conversion factor. It's commonly used in healthcare reimbursement systems.

2. How Does the Calculator Work?

The calculator uses the payment formula:

Where:

• \( Total\ RVU \) — Sum of work, practice expense, and malpractice RVUs for a CPT code
• \( Conversion\ Factor \) — Dollar amount per RVU (set annually by CMS or other payers)

Explanation: The equation multiplies the total RVUs assigned to a procedure by the conversion factor to determine the payment amount.

3. Importance of RVU Calculation

Details: Accurate fee calculation is essential for proper medical billing, revenue cycle management, and understanding reimbursement rates for medical services.

4. Using the Calculator

Tips: Enter the total RVU value for the CPT code and the applicable conversion factor. Both values must be positive numbers.

5. Frequently Asked Questions (FAQ)

Q1: Where can I find RVU values for CPT codes?
A: RVU values are published annually by CMS in the Medicare Physician Fee Schedule.

Q2: Does the conversion factor change?
A: Yes, CMS updates the conversion factor annually. Private payers may use different factors.

Q3: What components make up Total RVU?
A: Total RVU = Work RVU + Practice Expense RVU + Malpractice RVU.

Q4: Are geographic adjustments needed?
A: Yes, payments are typically adjusted by geographic practice cost indices (GPCI).

Q5: Can this be used for all payers?
A: While Medicare uses this system, private payers may have different reimbursement methodologies.