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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