Free and Legal 2021 RVU-RBRVS Calculator
Welcome to the free 2021 RBRVS Calculator.
As you may know, the AMA won’t let anyone freely distribute an RVU calculator that includes CPT codes without signing a limiting and expensive licensing agreement. 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. Those of you who have a CPT license - which should be any clinician or practice in the US who submits claims - can freely download the CPT data from CMS and place it in the calculator.
You can use this spreadsheet with the data that you can download from CMS to make a fairly sophisticated RVU calculator and payment analysis in about five 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.
Why is 2021 special? As of this initial post, we live in a moment of chaos. On one hand, the Feds have jacked up the RVUs on the primary care codes most important to pediatricians - sick E&Ms, well visits, and imms admin. On the other hand, they've lowered the overall rate for RVUs for everyone to, in part, make up for that. The Feds have also redefined how we determine E&M levels. We don't know what any of this means yet!
Why do I do all this work, especially for free? Because I remain incensed that the very rule set used to determine what and how physicians are paid remains both obscure, obfuscated, and (partially) copyrighted and you either have to pay someone thousands of dollars for weak-ass software or super-nerd your way through it. Obviously, as part of PCC's mission as a Benefit Corporation, I prefer the latter method and am glad to share my work with you.
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 relative to Medicare. 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.
What would you use this for? Many things!
- Ensure that your pricing is logical and supportable. Enter your fees and see where you don't line up.
- Compare your pricing to another pricing set - a fee schedule, perhaps, or another practice. When you get that rate proposal from a payor, how else are you going to judge it?
- You want to judge the real fee schedule for a payor. If you have a contract from an insurance company that says you'll be paid 125% of Medicare (or whatever), this is your chance to confirm. Enter your actual payments to see how they compare. I always find mistakes from the payors when I compare their contracted fee schedules to what they actually pay!
- Compare the fee schedules of two payors. If you create two spreadsheets, one each for two different payors, you can enter in their payment information and conclude something like, "Payor A pays me 110% of Medicare, on average, while Payor B pays me 90%!"
The bottom line is that all insurance companies use the RBRVS, but they use it poorly or in a way that harms you. Arm yourself with the data!
I've abandoned trying to make working models for both Excel and Libreoffice - I now have one that everyone should be able to use - just download the new version here.
How does it work?
- Download the Free 2021 RVU Calculator.
- Head to CMS and download the latest 2021 RVU zip file. This link brings you to the list of RVU files CMS hosts - note that this calculator only works for 2021! Look out for newer or previous versions. You have to agree to the license and usage rules from CMS, of course.
- Extract the PPRRVU21*.csv 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 21, and ends in .csv and is larger than 2MB. It will have about 17,000 CPT codes in it. Note: the suggestion to import the CSV file is a change from previous years - apparently using the CSV file makes the matching happen more easily, especially for Excel users, due to data type definitions. You can also open the .xls version, of course.
- Cut and paste the entire page of data from the PPRRVU21*.csv file into the tab marked “PPRRVU21_Jan.csv″ in the RVU Calculator spreadsheet. Don’t panic if it seems to freeze for a minute, it’s a lot of data. Note that with multiple updates to the RVU file every year, you may not have a "JAN" file - that's OK.
- Go to the middle tab, "GPCI21." Scroll down until you find your locality. Once you locate it, copy the four fields for step 6 - you want the name and then then 3 numbers that follow.
- Go back to the first tab, "Front Page," and paste your GPCI results into the cell E6. It should overwrite the Name and 3 GPCI value fields.
- Pick a Medicare Multiplier in B6 or leave it at 100%. Then, enter some CPT codes in column A. Gasp in amazement.
- Put some unit volumes, prices, and payments in and watch what happens.
- Any light green field is where you are expected to add your own information.
- The friendly red columns represent data that the calculator looks up for you.
- The blue columns are where the calculator does fun math to provide pricing and payment comparison to Medicare.
Huge Improvements since 2019:
- I cleaned up some of the visuals to make it easier to read. And I changed the layout of the data input fields (columns A-D) to make it a lot easier to add data.
- I extended the math to work with up to 240 codes or so, now. I also cleaned up column headers, etc. Wow, I was messy.
- I made even more layout changes this year.
Go crazy, tell me what you find.