RVU definition
Examples of RVU in a sentence
For that CPT code, we adopt the RVU value established by the gap fill-fee source, and determine the fee schedule amount for that CPT code by applying to the gap-fill RVU the same conversion factor that we apply to the CMS RVU for those CPT codes that have CMS RVUs. At such time in the future as CMS publishes its own RVU value for that CPT code, we would begin using the primary fee source, CMS, to derive the fee for that code and no longer use the alternate source.
In the event that Medicare has not published an RVU for a given code, MVP will pay these codes at the all other referred ambulatory rates without CPT/HCPCS code at reasonable charges.
Ordinarily, United’s fee schedule is updated using the original construction methodology along with the then-current RVU of the published CPT code.
There is no separate payment for these services even if an RVU is listed.
For each of the 23 CPT/HCPCS code groups, representative CPT/ HCPCS codes are statistically selected and weighted so as to give a weighted average RVU comparable to the weighted average RVU of the entire CPT/HCPCS code group (the selected CPT/HCPCS codes are set forth in the Milliman USA, Inc., Health Cost Guide- lines fee survey); see paragraph (a)(3) of this section for Data Sources.
Using the nationwide 80th percentile charges for the selected CPT/HCPCS codes from paragraph (f)(3) of this sec- tion, a nationwide conversion factor is calculated for each of the 23 CPT/ HCPCS code groups by dividing the weighted average charge by the weight- ed average RVU.
A mathematical approximation method- ology based on least squares techniques is applied to the RVUs specified for each of the groups set forth in para- graph (l)(2)(i) of this section, yielding two charge amounts for each HCPCS code group: a charge amount per incre- mental RVU, and a fixed charge amount.
Using the 80th percentile charges for the selected CPT/HCPCS codes from paragraph (f)(3) of this section for each geographic area, a geographic area-spe- cific conversion factor is calculated for each of the 23 CPT/HCPCS code groups by dividing the weighted average charge by the weighted average geo- graphically-adjusted RVU.
The resulting nation- wide total RVUs are multiplied by the geographic area adjustment factors de- termined pursuant to paragraph (f)(2)(iv) of this section to obtain the area-specific total RVUs.(iv) RVU geographic area adjustment factors for CPT/HCPCS codes that do not have Medicare RVUs, including codes that are designated as unlisted proce- dures.
Fees for Behavioral Health Services are determined using the conversion factor of $49.71 x RVU for each procedure as explained above.Client Medical Records Request....................................