Pediatric Pricing and RBRVS Calculator

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.

Practice Name:
Medicare Pricing Multiplier:		%
Region:		Region: Generic Alabama Alaska Arizona Arkansas California - Anaheim/Santa Ana California - Los Angeles California - Marin/Napa/Solano California - Oakland/Berkeley California - San Francisco California - San Mateo California - Santa Clara California - Ventura California - Rest of California Colorado Connecticut Delaware DC + MD/VA Suburbs Florida - Fort Lauderdale Florida - Miami Florida - Rest of Florida Georgia - Atlanta Georgia - Rest of Georgia Hawaii/Guam Idaho Illinois - Chicago Illinois - East St. Louis Illinois - Suburban Chicago Illinois - Rest of Illinois Indiana Iowa Kansas Kentucky Louisiana - New Orleans Louisiana - Rest of Louisiana Maine - Southern Maine Maine - Rest of Maine Maryland - Baltimore/Surr. Cntys Maryland - Rest of Maryland Massachusetts - Metropolitan Boston Massachusetts - Rest of Massachusetts Michigan - Detroit Michigan - Rest of Michigan Minnesota Mississippi Missouri - Metropolitan Kansas City Missouri - Metropolitan St. Louis Missouri - Rest of Missouri Montana Nebraska Nevada New Hampshire New Jersey - Northern NJ New Jersey - Rest of New Jersey New Mexico New York - Manhattan New York - NYC Suburbs/Long Island New York - Poughkpsie/Northern NYC Suburbs New York - Queens New York - Rest of New York North Carolina North Dakota Ohio Oklahoma Oregon - Portland Oregon - Rest of Oregon Pennsylvania - Metropolitan Philadelphia Pennsylvania - Rest of Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas - Austin Texas - Beaumont Texas - Brazoria Texas - Dallas Texas - Fort Worth Texas - Galveston Texas - Houston Texas - Rest of Texas Utah Vermont Virgin Islands Virginia Washington - Seattle (King County) Washington - Rest of Washington West Virginia Wisconsin Wyoming

2003 MPFS: $

2004 MPFS: $

2005 MPFS: $

2006 MPFS: $

2007 MPFS: $

2008 MPFS: $

or

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:

1. Enter your Practice Name if you would like a nice printable report. This is not required, but it makes for a better looking result.


2. 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%.


3. 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.


4. Choose your Region from the pull-down menu. A non-adjusted location ("Generic") appears by default.


5. 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
99212		0.99	$54.63		0.99	$55.45		1.02	$57.99
Office/outpatient visit, est		Adj RVU * MPFS * Multi 0.99 * $36.79 * 150%			Adj RVU * MPFS * Multi 0.99 * $37.34 * 150%			Adj RVU * MPFS * Multi 1.02 * $37.90 * 150%

• 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 Brochure.
• 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.