cpt® Code/Relative Value Search
The payment amount for each service paid under the physician fee schedule is the product of three factors:
(1) a nationally uniform relative value for the service (2) a geographic adjustment factor for each physician fee schedule area; and (3) a nationally uniform conversion factor for the service. The conversion factor converts the relative values into payment amounts.
For each physician fee schedule service, there are three relative values (1) an RVU for physician work; (2) an RVU for practice expenses; and (3) an RVU for malpractice expense. For each of these components of the fee schedule, there is a geographic practice cost index (GPCI) for each fee schedule area. The GPCIs reflect the relative costs of practice expenses, malpractice insurance, and physician work in an area compared to the national average for each component.
The general formula for calculating the Medicare relative value payment amount for a given service in a given fee schedule area can be expressed as:
Payment=[(RVU work x GPCI work) + (RVU practice expense x GPCI practice expense) + (RVU malpractice x GPCI malpractice)] x Conversion Factor
The Conversion Factor for calendar year (CY) 2006 is $37.8975
|Relative Value Unit||Mississippi||Manhattan, NY|
|Practice Expense RVU||0.837||1.351|
The national average GPCI for all components is equal to 1.00.
CPT Code/Relative Value Search
The CPT coding system offers doctors across the country a uniform system that streamlines the reporting process and increases efficiency. For more than four decades, physicians and other qualified healthcare professionals have used CPT to communicate with colleagues, patients, hospitals and insurers about the procedures they have performed, all at no cost to the U.S. Government and taxpayers.
This page gives users of CPT the opportunity to perform CPT code searches and obtain information about Medicare's relative value payment amount associated with the codes. Searches can be performed using 5 digit CPT code numbers or key word(s) in the code description.