Others titles
- Medicare Information
- Physician Fee Schedule Relative Value Units 2022
- Physician Fee Schedule Relative Value Units 2021
- The RVUs and Policy Indicators Associated With Physician Fee Schedule
- Physician Fee Schedule RVUs 2022
- Physician Fee Schedule RVUs 2021
- Facility Practice Expense RVUs 2022
- Facility Practice Expense RVUs 2021
- Diagnostic Imaging Family Indicator for RVUs 2022
- Diagnostic Imaging Family Indicator for RVUs 2021
Keywords
- Physician Fee Schedule Relative Value Units 2024
- RVUs 2024
- Physician Fee Schedule Relative Value Units 2023
- RVUs 2023
- The RVUs and Policy Indicators Associated With Physician Fee Schedule
- Physician Fee Schedule
- Medicare Health Insurance
- Medicare Coverage
- Medicare Insurance
- Physician Fee Schedule
Physician Fee Schedule Relative Value Units
This dataset contains information on services covered by the Medicare Physician Fee Schedule (MPFS) in 2024. For more than 10,000 physician services; the dataset contains the associated relative value units (RVUs), a fee schedule status indicator, and various payment policy indicators needed for payment adjustment (i.e., payment of assistant at surgery, team surgery, bilateral surgery, etc.).
Get The Data
- ResearchNon-Commercial, Share-Alike, Attribution Free Forever
- CommercialCommercial Use, Remix & Adapt, White Label Log in to download
Description
The formula for 2024 physician fee schedule payment amount is as follows:
2024 Non-Facility Pricing Amount =
[(Work RVU * Work GPCI) +
(Non-Facility PE RVU * PE GPCI) +
(MP RVU * MP GPCI)] * Conversion Factor (CF)
2024 Facility Pricing Amount =
[(Work RVU * Work GPCI) +
(Facility PE RVU * PE GPCI) +
(MP RVU * MP GPCI)] * Conversion Factor
Certain therapy codes will receive a 50 percent reduction to the PE.
Section 5102(b) of the Deficit Reduction Act of 2005 requires a payment cap on the technical component (TC) of certain diagnostic imaging procedures and the TC portions of the global diagnostic imaging services. This cap is based on the Outpatient Prospective Payment System (OPPS) payment. To implement this provision, the physician fee schedule amount is compared to the OPPS payment amount and the lower amount is used in the formula below to calculate payment.
2024 OPPS Non-Facility Payment Amount =
[(Work RVU * Work GPCI) + (OPPS Non-Facility PE RVU * PE GPCI) +
(OPPS MP RVU * MP GPCI)] * Conversion Factor
2024 OPPS Facility Payment Amount =
[Work RVU * Work GPCI) + (OPPS Facility PE RVU * PE GPCI) +
(OPPS MP RVU * MP GPCI)] * Conversion Factor
About this Dataset
Data Info
Date Created | 2017-01-01 |
---|---|
Last Modified | 2024-05-28 |
Version | 2024-05-28 |
Update Frequency |
Annual |
Temporal Coverage |
2024 |
Spatial Coverage |
United States |
Source | John Snow Labs; Centers for Medicare and Medicaid Services; |
Source License URL | |
Source License Requirements |
• CPT codes and descriptions only are copyright 2017 American Medical Association. All rights reserved. Applicable FARS/DFARS apply • All dental codes copyright 2017/18 American Dental Association, all rights reserved. |
Source Citation |
• CPT codes and descriptions only are copyright 2017 American Medical Association. All rights reserved. Applicable FARS/DFARS apply • All dental codes copyright 2017/18 American Dental Association, all rights reserved. |
Keywords | Physician Fee Schedule Relative Value Units 2024, RVUs 2024, Physician Fee Schedule Relative Value Units 2023, RVUs 2023, The RVUs and Policy Indicators Associated With Physician Fee Schedule, Physician Fee Schedule, Medicare Health Insurance, Medicare Coverage, Medicare Insurance, Physician Fee Schedule |
Other Titles | Medicare Information, Physician Fee Schedule Relative Value Units 2022, Physician Fee Schedule Relative Value Units 2021, The RVUs and Policy Indicators Associated With Physician Fee Schedule, Physician Fee Schedule RVUs 2022, Physician Fee Schedule RVUs 2021, Facility Practice Expense RVUs 2022, Facility Practice Expense RVUs 2021, Diagnostic Imaging Family Indicator for RVUs 2022, Diagnostic Imaging Family Indicator for RVUs 2021 |
Data Fields
Name | Description | Type | Constraints |
---|---|---|---|
HCPCS_Code | CPT or Level 2 HCPCS number | string | - |
Modifier | For diagnostic tests, a blank in this field denotes the global service and the following modifiers identify the components:26 = Professional component, TC = Technical component | string | - |
Description | Description of the code | string | - |
Status_Code | A = Active Code. B = Bundled Code. C = Carriers price the code. D = Deleted Codes. E = Excluded from Physician Fee Schedule by regulation. F = Deleted/Discontinued Codes. G = Not valid for Medicare purposes. H = Deleted Modifier. I = Not valid for Medicare purposes. J = Anesthesia Services. M = Measurement codes. Used for reporting purposes only. N =Non-covered Services. P = Bundled/Excluded Codes. R = Restricted Coverage. T =Injections. X = Statutory Exclusion. Q = Therapy functional information code. | string | - |
Is_Used_For_Medicare_Payment | False denotes that a unit is not used for medicare payment. | boolean | - |
Work_RVU | Relative Value Unit (RVU) for the physician work in the service as published in the Federal Register Fee Schedule for Physicians Services for CY 2018. | number | level : Ratio |
NonFacility_PE_RVU | Relative Value Unit (RVU) for the resource-based practice expense for the non-facility setting, as published in the Federal Register Fee Schedule for Physicians Services for CY 2018. | number | level : Ratio |
Is_NonFacility_NA_Indicator | False denotes that a unit is not used for non facility indicator. | boolean | - |
Facility_PE_RVU | Relative Value Unit (RVU) for the resource-based practice expense for the facility setting, as published in the Federal Register Fee Schedule for Physicians Services for CY 2018. | number | level : Ratio |
Is_Facility_NA_Indicator | False denotes that a unit is not used for non facility indicator. | boolean | - |
Malpractice_RVU | RVU for the malpractice expense for the service as published in the Federal Register Fee Schedule for Physicians' Services for CY 2087. | number | level : Ratio |
Total_NonFacility_RVU | Sum of work, non-facility practice expense, and malpractice expense RVUs. | number | level : Ratio |
Total_Facility_RVU | Sum of work, facility practice expense, and malpractice expense RVUs. | number | level : Ratio |
PCTC_Indicator | Indicator | integer | level : Nominal |
Preoperative_Percentage | Percentage for preoperative portion of global package. | number | level : Nominal |
Intraoperative_Percentage | Percentage for intraoperative portion of global package, including postoperative work in the hospital. | number | level : Nominal |
Postoperative_Percentage | Percentage for postoperative portion of global package that is provided in the office after discharge from the hospital. | number | level : Nominal |
Multiple_Procedure_Modifier_51 | Indicates applicable payment adjustment rule for multiple procedures: 0=No payment adjustment rules for multiple procedures apply. If procedure is reported on the same day as another procedure, base the payment on the lower of (a) the actual charge, or (b) the fee schedule amount for the procedure. | integer | level : Nominal |
Bilateral_Surgery_Modifier_50 | Indicates services subject to payment adjustment. | integer | level : Nominal |
Assistant_at_Surgery | Indicates services where an assistant at surgery is never paid for per Medicare Claims Manual. | integer | level : Nominal |
Co_Surgeons_Modifier_62 | Indicates services for which two surgeons, each in a different specialty, may be paid. | integer | level : Nominal |
Team_Surgery_Modifier_66 | Indicates services for which team surgeons may be paid. 0=Team surgeons not permitted for this procedure.1=Team surgeons could be paid, though supporting documentation required to establish medical necessity of a team; pay by report. 2=Team surgeons permitted; pay by report. | integer | level : Nominal |
Endoscopic_Base_Code | Code which identifies an endoscopic base code for each code with a multiple surgery indicator of 3. | string | - |
Conversion_Factor | This is the multiplier that transforms relative values into payment amounts. This conversion factor reflects the MEI update adjustment. For 2002 and beyond, there is a single conversion factor for all | number | level : Nominal |
Physician_Supervision_of_Diagnostic_Procedures | This field is for use in post-payment review. | string | - |
Diagnostic_Indicator_Imaging_Family | This field identifies the applicable diagnostic service family for that HCPCS codes with a multiple procedure indicators of ‘4’. For services effective January 1, 2011 and after, family indicators 01 – 11 will not be populated. The values are: | integer | level : Nominal |
NonFacility_PE_Used_For_OPPS_Payment_Amount | The OPPS Payment Amount calculated using these values is compared to the Medicare Physician Fee Schedule to determine applicability of the OPPS Imaging Cap mandated by Section 5102(b) of the Deficit Reduction Act of 2005. | number | level : Nominal |
Facility_PE_Used_For_OPPS_Payment_Amount | The OPPS Payment Amount calculated using these values is compared to the Medicare Physician Fee Schedule to determine applicability of the OPPS Imaging Cap mandated by Section 5102(b) of the Deficit Reduction Act of 2005. | number | level : Nominal |
Malpractice_Used_For_OPPS_Payment_Amount | The OPPS Payment Amount calculated using these values is compared to the Medicare Physician Fee Schedule to determine applicability of the OPPS Imaging Cap mandated by Section 5102(b) of the Deficit Reduction Act of 2005. | number | level : Nominal |
Data Preview
HCPCS Code | Modifier | Description | Status Code | Is Used For Medicare Payment | Work RVU | NonFacility PE RVU | Is NonFacility NA Indicator | Facility PE RVU | Is Facility NA Indicator | Malpractice RVU | Total NonFacility RVU | Total Facility RVU | PCTC Indicator | Preoperative Percentage | Intraoperative Percentage | Postoperative Percentage | Multiple Procedure Modifier 51 | Bilateral Surgery Modifier 50 | Assistant at Surgery | Co Surgeons Modifier 62 | Team Surgery Modifier 66 | Endoscopic Base Code | Conversion Factor | Physician Supervision of Diagnostic Procedures | Diagnostic Indicator Imaging Family | NonFacility PE Used For OPPS Payment Amount | Facility PE Used For OPPS Payment Amount | Malpractice Used For OPPS Payment Amount |
A0021 | Outside state ambulance serv | I | 0 | 0 | 0 | 0 | 0 | 0 | 9 | 0 | 0 | 0 | 9 | 9 | 9 | 9 | 9 | 33.2875 | 9 | 99 | 0 | 0 | 0 | |||||
A0080 | Noninterest escort in non er | I | 0 | 0 | 0 | 0 | 0 | 0 | 9 | 0 | 0 | 0 | 9 | 9 | 9 | 9 | 9 | 33.2875 | 9 | 99 | 0 | 0 | 0 | |||||
A0090 | Interest escort in non er | I | 0 | 0 | 0 | 0 | 0 | 0 | 9 | 0 | 0 | 0 | 9 | 9 | 9 | 9 | 9 | 33.2875 | 9 | 99 | 0 | 0 | 0 | |||||
A0100 | Nonemergency transport taxi | I | 0 | 0 | 0 | 0 | 0 | 0 | 9 | 0 | 0 | 0 | 9 | 9 | 9 | 9 | 9 | 33.2875 | 9 | 99 | 0 | 0 | 0 | |||||
A0110 | Nonemergency transport bus | I | 0 | 0 | 0 | 0 | 0 | 0 | 9 | 0 | 0 | 0 | 9 | 9 | 9 | 9 | 9 | 33.2875 | 9 | 99 | 0 | 0 | 0 | |||||
A0120 | Noner transport mini-bus | I | 0 | 0 | 0 | 0 | 0 | 0 | 9 | 0 | 0 | 0 | 9 | 9 | 9 | 9 | 9 | 33.2875 | 9 | 99 | 0 | 0 | 0 | |||||
A0130 | Noner transport wheelch van | I | 0 | 0 | 0 | 0 | 0 | 0 | 9 | 0 | 0 | 0 | 9 | 9 | 9 | 9 | 9 | 33.2875 | 9 | 99 | 0 | 0 | 0 | |||||
A0140 | Nonemergency transport air | I | 0 | 0 | 0 | 0 | 0 | 0 | 9 | 0 | 0 | 0 | 9 | 9 | 9 | 9 | 9 | 33.2875 | 9 | 99 | 0 | 0 | 0 | |||||
A0160 | Noner transport case worker | I | 0 | 0 | 0 | 0 | 0 | 0 | 9 | 0 | 0 | 0 | 9 | 9 | 9 | 9 | 9 | 33.2875 | 9 | 99 | 0 | 0 | 0 | |||||
A0170 | Transport parking fees/tolls | I | 0 | 0 | 0 | 0 | 0 | 0 | 9 | 0 | 0 | 0 | 9 | 9 | 9 | 9 | 9 | 33.2875 | 9 | 99 | 0 | 0 | 0 |