Check your math: CMS tinkered with the RVUs for thousands of codes

by: Julia Kyles, CPC Jan 14, 2021

Pay close attention when you rerun your revenue calculations with the updated conversion factor. Part B News analysis uncovered thousands of revised relative value units (RVU) in the relative value file that CMS created Jan. 4. If you base your new calculations on the total relative value units CMS released with the 2021 Medicare physician fee schedule, your results may contain mistakes.

For example, the original relative value file assigned a total of 3.81 non-facility RVUs to established patient office visit code 99214. That works out to $132.94 without locality adjustments when multiplied by $34.8931 the new conversion factor.

The revised file gives the code 3.76 RVUs with a resulting $131.20 payment. The loss of $1.74 for a single encounter might go unnoted but could add up to a significant shortfall at the end of the year.

Check the chart below for the impact on the office visit codes and be aware that CMS made changes to more than 3,000 E/M and procedure codes. To be safe, use the new file to recalculate.

Code	Short descriptor	Revised 2021 RVU	Original 2021 RVU	% RVU difference	Revised 2021 $	Original 2021 $	Change to $
99202	Office o/p new sf 15-29 min	2.12	2.13	-0.47%	$73.97	$74.32	-$0.35
99203	Office o/p new low 30-44 min	3.26	3.28	-0.61%	$113.75	$114.45	-$0.70
99204	Office o/p new mod 45-59 min	4.87	4.93	-1.22%	$169.93	$172.02	-$2.09
99205	Office o/p new hi 60-74 min	6.43	6.51	-1.23%	$224.36	$227.15	-$2.79
99211	Office o/p est minimal prob	0.66	0.68	-2.94%	$23.03	$23.73	-$0.70
99212	Office o/p est sf 10-19 min	1.63	1.67	-2.40%	$56.88	$58.27	-$1.40
99213	Office o/p est low 20-29 min	2.65	2.68	-1.12%	$92.47	$93.51	-$1.05
99214	Office o/p est mod 30-39 min	3.76	3.81	-1.31%	$131.20	$132.94	-$1.74
99215	Office o/p est hi 40-54 min	5.25	5.33	-1.50%	$183.19	$185.98	-$2.79

Blog Tags: CMS, conversion factor, E/M services, fee schedule

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