Free 2016 RVU Calculator

Welcome to the free 2016 RBRVS Calculator.

As you may know, the AMA won’t let anyone provide a free RVU calculator that includes CPT codes due to their CPT copyrights. In an abundance of caution and, because in our unhappy experience, the AMA interprets its rights (in our opinion) overly broadly, we created this tool for those of you who have a CPT license that allows for a use such as this. In theory, that should mean any practice that submits insurance claims.

To make a long story short, you can use this spreadsheet with the data that you can download from CMS to make a fairly sophisticated RVU calculator in about 5 minutes. This will allow you to fairly set your prices, analyze a payer contract, or double-check your expected payments.  It also lets you perform a lot of other analysis tricks that the cool kids can figure out.

What does it do, technically? It allows you to choose your CMS-driven location, set a Medicare Multiplier, and then, on a code-by-code basis, determine your pricing level. If you then take the time to include your code volume and pricing, it will determine your practice’s FACF (i.e., how much you charge, on average, relative to Medicare). If you then provide your payment information, it will compare them to the Medicare fee schedule for you.

As of this writing, I have created an LibreOffice version. The Excel version is finished, but I need testers. I don’t trust Excel.  Someone tell me if it’s OK!


How does it work?

  1. Download one of the above spreadsheets.
  2. Head to CMS and download the latest 2016 RVU zip file. (This link brings you to the January 2015 release; be on the look out for newer versions.) You have to agree to the license and usage rules from CMS, of course.
  3. Extract the PPRRVU16_V1110_V2.xlsx file from the zip file. Note that the actual file name will change based on version of the RVU data file you download. You are essentially looking for a file that begins with “PPRVU,” has the number 16, and ends in .xlsx and is larger than 2MB.  It will have just under 20,000 CPT codes in it.
  4. Cut and paste the entire page of data from the PPRRVU16_V1110_V2.xlsx file into the tab marked “PPRRVU16_V1110_V2.xlsx″ in the RVU Calculator spreadsheet. Don’t panic if it seems to freeze for a minute, it’s a lot of data.
  5. Go back to the first tab.  Choose your locality with the pulldown menu. Pick a Medicare Multiplier. Then, enter some CPT codes in column A. Gasp in amazement.
  6. Put some unit volumes, prices, and payments in and watch what happens. Any field marked in a light blue-gray is a place where you can enter info.

I’d love for some guinea pigs to try this out and tell me what doesn’t work. PCC clients, natch, can do this already with our reports, so I want to hear from the rest of you :-)

17 replies
  1. Sean
    Sean says:

    So I have set up the calculator as described. How do I determine what I will be reimbursed based on what I charge? For instance, I am a chiropractor and I want to bill a 98940. Is there a way I can put in a potential charge (i.e. $50) and figure out what I will get paid? Thanks for help.

    Reply
  2. Jennifer McAndrew
    Jennifer McAndrew says:

    So when I downloaded and opened the LibreOffice version, Excel said it had to modify the document so it would “work” and I got as far as “picking a location from the drop down on the Front Tab” – there was no drop down so I guess I can’t use this sheet?

    Reply
  3. Paul Darby
    Paul Darby says:

    Is there a way I can modify the GPCI factors without screwing up the program calculations? Our primary payer is a workers’ comp insurer who uses the following numbers: Work GPCI 1.008, PE GPCI 1.057, and MP GPCI 0.481; conversion factor $61.52. I assume entering $61.52 where your program says “Medicare Factor” will take care of one thing, but what about the GPCI’s? Thanks.

    Reply
  4. Matt
    Matt says:

    Hello Chip: I saw the reference to your RVU calculator in Mark Dietrich’s latest healthcare publication. I have an internally developed RVU model that I was planning to enhance but figured I would take a look at your model first. Dietrich includes an example in his book that uses an enhanced RVU model that isolates the TC element of relevant procedures. Are you willing to share that version or do you only offer the basic model?

    Thanks

    Reply
    • Chip Hart
      Chip Hart says:

      I’m not at all familiar with Mark Dietrich’s work, so I can’t quite comment on that. I’d love to get a reference to it, though, so I can read about it.

      My calculator isn’t a model, per se – just something to easily calculate the non-facility values/prices for non-Medicare physicians (namely, pediatricians, my clients). It’s easily modified to isolate the TC-procedures, but I’ve never done that work simply because it doesn’t affect my clients. You’re welcome to manipulate the spreadsheet as you see fit. And if I can answer any questions, I will – thanks!

      Reply
      • Matt
        Matt says:

        Mark’s book is titled “Healthcare Industry Finance and Valuation.” It was written in collaboration with BVR (Business Valuation Resources) and the AHLA (American Health Lawyers Association). I reread his reference to your spreadsheet and I may have initially misinterpreted it. I think Mark modified your spreadsheet to pick up the TC component. I don’t think that will be a difficult edit so I will just make that change. Thanks

        Reply

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