Insurance Relative Value Unit

You may wonder how cpt codes correspond to a dollar value and why.

Insurance relative value unit. To determine payment amounts cms multiplies the conversion factor cf by the relative value unit rvu assigned to the procedure code s. 1 in 1991 the relative value scale update committee ruc was created by the american medical association to make. It is determined by assigning weight to such factors as personnel time level of skill and sophistication of equipment required to render. From rvs to rbrvs.

Before rvus were used medicare paid for physician services using usual customary and reasonable rate setting which led to payment variability the omnibus budget reconciliation act of 1989 enacted a medicare fee schedule and as of 2010 about 7 000 distinct physician services were listed. The work rvu calculator provides quick analysis of work relative value units associated with cpt and hcpcs level ii codes. Understand relative value units. The services are classified under a nomenclature based on the current procedural.

Every cpt code has been assigned something called a relative value unit or rvu that determines the cost of a service. In response to a need for a standardized language to describe medical services the current procedural terminology cpt coding system was created in 1966 this system persists today and is used by most payers to communicate standardized information about medical services. The cf converts the rvu of a procedure into a dollar amount for reimbursement to the provider. The study is updated every two years.

The reasonable value of any service or accommodation shall be calculated by multiplying the relative value unit assigned to the service or accommodation by the applicable conversion factor prescribed in r590 267 5. By entering the appropriate code and number of units associated with it you will receive the total work rvus and individual work rvu value for that code. A person found to be in violation of this rule shall be subject to penalties as provided under section 31a 2. An historical perspective beginning in the 1950 s systems were developed to establish relative values of medical services.

The first edition of this tool used a 3 digit coding system to describe services and assigned a unit value uv to each service. They coined the term relative value because each service unit value could be measured. Depends on its relative value units rvus which rank on a common scale the resources used to provide each service. Since 1990 the insurance department has produced a relative value study rvs to determine the reasonable value of medical expenses for automobile personal injury protection no fault coverage as required by subsection 31a 22 307 2 of the utah code.

These resources include the physician s work the expenses of the physician s practice and professional liability insurance. The system used by medicare and many hmos is called the resource based relative value scale rbrvs. The mpfs is updated annually at a minimum.