Pediatric practices are woefully inadequate when it comes to setting prices for the work they do. Driven by an insurance industry that forces inappropriate fee schedules and a society that undervalues their services, it's no wonder that pediatricians are so bad at it.
Introduction to the RVU Calculator
Using this RVU-based calculator, pediatricians can now set their prices for a set of their most important CPT codes. Follow the simple directions below to ensure that your primary codes are priced properly and then follow up on all of your other codes.
N.B.: Because of a change the AMA forced us to make to the calculator, you are no longer allowed to search for individual codes. Instead, you will automatically be presented with a list of the the most important pediatric codes for which Medicare provides RVU values.
Current Procedural Terminology (CPT?) copyright 2003-2005 American Medical Association.
Instructions:
- Enter your Practice Name if you would like a nice printable report. This is not required, but it makes for a better looking result.
- Choose a Medicare Pricing Multiplier. If you would like to see flat Medicare rates, for example, leave the Pricing Multiplier at 100%. For a benchmark, many pediatric practices fall between 115-140% for private coverage. As a comparison, other specialties run from 200 to 400%.
- Update the MPFS that you wish to use only if you wish to use a different MPFS for the chosen year. By default, the calculator will use the proper MPFS for each year.
- Choose your Region from the pull-down menu. A non-adjusted location ("Generic") appears by default.
- Click on the "Calculate Fees!" button to receive a simple, printable form.
How to Read the Form
Your pricing form should look something like this:
| CPT Code ® | 2003 RVU | 2003 Price | 2004 RVU | 2004 Price | 2005 RVU | 2005 Price | |||||||||||||||||||||||||||||||||
| Description | 2003 Math | 2004 Math | 2005 Math | ||||||||||||||||||||||||||||||||||||
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| 99212 | 0.99 | $54.63 | 0.99 | $55.45 | 1.02 | $57.99 | |||||||||||||||||||||||||||||||||
| Office/outpatient visit, est |
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- The "CPT Code" (blue) box identifies each CPT code.
- The "Description" (green) box indicates the description for each code.
- The "RVU" (orange) box gives you the total RVU score for each CPT, by year.
- The "Price" (red) box gives you the proper price, based on your multiplier and region, for each code and year.
- Finally, the "Math" box (yellow), gives a quick overview of the math that went into calculating the proper RVU score and price for each code. This includes multiplying the Geographically Adjusted RVU score by the Medicare Conversion Factor (MPFS) and your Pricing Multiplier.
Please note: previous incarnations of this calculator allowed users to examine the RVU data for any CPT code. Unfortunately, the AMA felt that this public service was in violation of their copyrights. While we respectfully disagree, PCC does not have the resources to resolve this matter in a manner that will allow the public service to continue. We encourage you to make the AMA aware of your opinions on this matter.
Links
There are quite a few on-line resources for working with RVUs in your practice. Among our favorites are:- PCC's article on setting your prices, of course!
- The AAP's RBRVS Documents.
- Medicare's Physician Fee Schedule information, which also leads you to the data files themselves.
- Medicare also offers a free RVU calculator of its own. Presuming you're licensed to use the data, you can look up all kinds of information about each code and do entire ranges of codes all at once.
- The AMA also offers a RVU Calculator to licensed users. Theirs is nice because it includes detailed descriptions for each code as well as links to AMA publications with updates and information about each code.
