Relative Value Units (RVUs)
Resource-based practice expenses relative value units (RVUs) comprise the core of physician fees paid under Medicare Part B payment policies. The CMS provides carriers with the fee schedule RVUs for all services except the following:
Those with local codes;
Those with national codes for which national relative values have not been established;
Those requiring “By Report” payment or carrier pricing; and
Those that are not included in the definition of physician’s services.
For services with national codes but for which national relative values have not been provided, carriers must establish local relative values (to be multiplied, in the carrier system, by the national CF), as appropriate, or establish a flat local payment amount.
Carriers may choose between these options.
The “Bu Report” services (with national codes or modifiers) include services with codes ending in 99, team surgery services, unusual services, pricing of the technical component for positron emission tomography reduced services, and radio nuclide codes A4641 and 79900. The status indicators of the Medicare fee schedule database identify these specific national codes and modifiers that carriers are to continue to pay on a “By Report: basis. Carriers mat not establish RVUs for them. Similarly, carriers may not establish RVUs for “By Report” services with local codes or modifiers.
Additionally, carriers do not establish fees for noncovered services or for services always bundled into another service. The MPFSDB identifies noncovered national codes and codes that are always bundled.
A. Diagnostic Procedures and Other Codes With Professional and Technical Components
For diagnostic procedure codes and other codes describing services with both professional and technical components, relative values are provided for the global service, the professional component, and the technical component. The CMS makes the determination of which HCPCS codes fall into this category.
B. No Special RVUs for Limited License Practitioners
There are no special RVUs for limited license physicians, e.g., optometrists and podiatrists. The fee schedule RVUs apply to a service regardless of whether a medical doctor, doctor of osteopathy, or limited license physician performs the service. Carriers may not restrict either physicians, independently practicing physical therapists, and/or other providers of covered services by the use of these codes.