Laura Summy, CPC, CRC Jun 28, 2023 4:35:32 PM 3 min read

Relative Value Units: How to Navigate Bundled and Unlisted Procedures

A Relative Value Unit (RVU) is a standard set by Medicare to determine the amount to pay providers depending on their productivity. It’s a number that defines the volume of work performed when treating patients and changes depending on the services or procedures listed in the Physician Fee Schedule.

Unsurprisingly, many providers are interested in the breakdown of this process, as it directly affects their pay rate. The better they understand RVUs, the clearer their financial outlook can be. 

So, what sorts of things impact an RVU?

As expected, a surgical procedure will pay more than a typical annual checkup. The procedure may be complex, requiring more time and skill by a specialist; therefore, it warrants a higher relative value unit. Other factors that affect the RVU rate include the place of service (POS), the type of specialist, and the time involved in the different services.

The RVU dollar amount for each CPT Code is determined by the American Medical Association (AMA) and Centers for Medicare and Medicaid (CMS) working together. The service codes range from 10000 to 99999, and most of them have RVUs assigned. There are four types of units: 

  • Physician Work – The provider’s time and expertise
  • Practice Expense – Supplies, equipment, and other staff
  • Malpractice – Professional liability expenses
  • Total – The rest added together

It’s important to note that, if more than one procedure is performed at the same time, their individual RVUs may not all be counted. When the procedures are related and fall under the National Correct Coding Initiative (NCCI) Edit rules, only the billable procedure RVUs will be allowed. Since the other service(s) cannot be billed, the provider doesn’t get credit for them. 

In the case of unlisted procedures, they do not have an RVU because they are not defined procedures. There isn’t a fee schedule or RVU assigned by the AMA. Most practices in this scenario will use a comparable code to determine the RVUs for whatever services were performed, as well as the fee schedule for billing to insurance. 

If you have questions or would like additional information on RVUs, please contact us directly to schedule a conversation.