Physician Fee Schedule Relative Value Units

$447.50 / year

This dataset contains information on services covered by the Medicare Physician Fee Schedule (MPFS) in 2017 and 2018. 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.).

Complexity

The formula for 2017 and 2018 physician fee schedule payment amount is as follows:

2017 and 2018 Non-Facility Pricing Amount =
[(Work RVU * Work GPCI) +
(Non-Facility PE RVU * PE GPCI) +
(MP RVU * MP GPCI)] * Conversion Factor (CF)

2017 and 2018 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.

2017 and 2018 OPPS Non-Facility Payment Amount =
[(Work RVU * Work GPCI) + (OPPS Non-Facility PE RVU * PE GPCI) +
(OPPS MP RVU * MP GPCI)] * Conversion Factor

2017 and 2018 OPPS Facility Payment Amount =
[Work RVU * Work GPCI) + (OPPS Facility PE RVU * PE GPCI) +
(OPPS MP RVU * MP GPCI)] * Conversion Factor

Date Created

2017-01-01

Last Modified

2020-01-31

Version

2020-01-31

Update Frequency

Annual

Temporal Coverage

2017 to 2020

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

N/A

Keywords

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Other Titles

Medicare Information, Physician Fee Schedule Relative Value Units 2020, Physician Fee Schedule Relative Value Units 2019, Physician Fee Schedule Relative Value Units 2018, Physician Fee Schedule Relative Value Units 2017, The RVUs and Policy Indicators Associated With Physician Fee Schedule, Physician Fee Schedule RVUs 2020, Physician Fee Schedule RVUs 2019, Physician Fee Schedule RVUs 2018, Physician Fee Schedule RVUs 2017, Facility Practice Expense RVUs 2020, Facility Practice Expense RVUs 2019, Facility Practice Expense RVUs 2018, Facility Practice Expense RVUs 2017, Diagnostic Imaging Family Indicator for RVUs 2020, Diagnostic Imaging Family Indicator for RVUs 2019, Diagnostic Imaging Family Indicator for RVUs 2018, Diagnostic Imaging Family Indicator for RVUs 2017

NameDescriptionTypeConstraints
HCPCS_CodeCPT or Level 2 HCPCS numberstring-
ModifierFor diagnostic tests, a blank in this field denotes the global service and the following modifiers identify the components:26 = Professional component, TC = Technical componentstring-
DescriptionDescription of the codestring-
Status_CodeA = 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.stringmaxLength : 1
Is_Used_For_Medicare_PaymentFalse denotes that a unit is not used for medicare payment.boolean-
Work_RVURelative Value Unit (RVU) for the physician work in the service as published in the Federal Register Fee Schedule for Physicians Services for CY 2018.numberlevel : Ratio
NonFacility_PE_RVURelative 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.numberlevel : Ratio
Is_NonFacility_NA_IndicatorFalse denotes that a unit is not used for non facility indicator.boolean-
Facility_PE_RVURelative 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.numberlevel : Ratio
Is_Facility_NA_IndicatorFalse denotes that a unit is not used for non facility indicator.boolean-
Malpractice_RVURVU for the malpractice expense for the service as published in the Federal Register Fee Schedule for Physicians' Services for CY 2087.numberlevel : Ratio
Total_NonFacility_RVUSum of work, non-facility practice expense, and malpractice expense RVUs.numberlevel : Ratio
Total_Facility_RVUSum of work, facility practice expense, and malpractice expense RVUs.numberlevel : Ratio
PCTC_IndicatorIndicatorintegerlevel : Nominal
Global_Surgery_DaysProvides time frames that apply to each surgical procedure.stringmaxLength : 3
Preoperative_PercentagePercentage for preoperative portion of global package.numberlevel : Nominal
Intraoperative_PercentagePercentage for intraoperative portion of global package, including postoperative work in the hospital.numberlevel : Nominal
Postoperative_PercentagePercentage for postoperative portion of global package that is provided in the office after discharge from the hospital.numberlevel : Nominal
Multiple_Procedure_Modifier_51Indicates 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.integerlevel : Nominal
Bilateral_Surgery_Modifier_50Indicates services subject to payment adjustment.integerlevel : Nominal
Assistant_at_SurgeryIndicates services where an assistant at surgery is never paid for per Medicare Claims Manual.integerlevel : Nominal
Co_Surgeons_Modifier_62Indicates services for which two surgeons, each in a different specialty, may be paid.integerlevel : Nominal
Team_Surgery_Modifier_66Indicates 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.integerlevel : Nominal
Endoscopic_Base_CodeCode which identifies an endoscopic base code for each code with a multiple surgery indicator of 3.string-
Conversion_FactorThis 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 allnumberlevel : Nominal
Physician_Supervision_of_Diagnostic_ProceduresThis field is for use in post-payment review.string-
Calculation_FlagAs of July 1, 2014 the value for the Calculation Flag for all HCPCS is “0”.integerlevel : Nominal
Diagnostic_Indicator_Imaging_FamilyThis 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:integerlevel : Nominal
NonFacility_PE_Used_For_OPPS_Payment_AmountThe 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.numberlevel : Nominal
Facility_PE_Used_For_OPPS_Payment_AmountThe 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.numberlevel : Nominal
Malpractice_Used_For_OPPS_Payment_AmountThe 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.numberlevel : Nominal
YearYear of Physician Fee Schedule Relative Value Units (2017 and 2018)date-
HCPCS CodeModifierDescriptionStatus CodeIs Used For Medicare PaymentWork RVUNonFacility PE RVUIs NonFacility NA IndicatorFacility PE RVUIs Facility NA IndicatorMalpractice RVUTotal NonFacility RVUTotal Facility RVUPCTC IndicatorGlobal Surgery DaysPreoperative PercentageIntraoperative PercentagePostoperative PercentageMultiple Procedure Modifier 51Bilateral Surgery Modifier 50Assistant at SurgeryCo Surgeons Modifier 62Team Surgery Modifier 66Endoscopic Base CodeConversion FactorPhysician Supervision of Diagnostic ProceduresCalculation FlagDiagnostic Indicator Imaging FamilyNonFacility PE Used For OPPS Payment AmountFacility PE Used For OPPS Payment AmountMalpractice Used For OPPS Payment AmountYear
A0021Outside state ambulance servI0000009XXX000999993690990002017
A0080Noninterest escort in non erI0000009XXX000999993690990002017
A0090Interest escort in non erI0000009XXX000999993690990002017
A0100Nonemergency transport taxiI0000009XXX000999993690990002017
A0110Nonemergency transport busI0000009XXX000999993690990002017
A0120Noner transport mini-busI0000009XXX000999993690990002017
A0130Noner transport wheelch vanI0000009XXX000999993690990002017
A0140Nonemergency transport airI0000009XXX000999993690990002017
A0160Noner transport case workerI0000009XXX000999993690990002017
A0170Transport parking fees/tollsI0000009XXX000999993690990002017