Conversion factor, practice expense and RVU factors combine to determine reimbursement rates
To calculate the rate of CMS reimbursement, the formula followed is:
Work RVU (a) + Practice Expense RVU (b) + Malpractice Expense (c) = sum x the 2019 national conversion of $36.0463 =
As an example, consider the following:
CPT Code |
2018 Work RVUs |
2018 Non-Facility Practice Expense RVUs |
2019 Non-Facility Practice Expense RVUs |
Mal-Practice RVUs |
2018 Total Non-Facility RVUs |
2019 Total Non-Facility RVUs |
CPT 95117: Professional services for allergen immunotherapy not including provision of allergenic extracts; two or more injections |
0.00 |
0.28 |
0.29 |
.01 |
0.29 |
0.30 |
The 2019 national reimbursement rate for CPT 95117 is as follows:
Work RVU (.00) + Practice Expense RVU (.29) + Malpractice Expense (.01) = .30 X the national conversion of $36.0463 = $10.81
The 2018 national reimbursement rate for CPT 95117 is as follows:
Work RVU (.00) + Practice Expense RVU (.28) + Malpractice Expense (.01) = .29 X the national conversion of $35.99 = $10.43
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Increase: $0.3729