Welcome to the free 2023 RVU 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 free and legal tool to allow physicians to perform important RVU work. 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.
Big change this year! I've moved the calculator to Google Sheets so, in theory, it is easier to use. Please take note of the new instructions below. Please let me know how it works for you, if you have any problems, etc.
The new spreadsheet is here. with the data that you can download from CMS to make a fairly sophisticated RVU calculator and payment analysis tool 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 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. At this point, 1000s of people download the calculator every year, across a broad range of specialties, and I haven't seen anyone else doing this work, so...
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 115% 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!
How does it work?
- Go to the new Google sheet calculator, located at https://bit.ly/2023RVUCalculator.
- Google should immediately prompt you to copy the file. Do this! You can create as many copies as you want for yourself. You can, in theory, even download them as XLS files to edit them off line. I can't access your results, they remains as private as ever.
- Head to CMS and download the latest 2023 RVU zip file. This link brings you to the list of RVU files CMS hosts - note that this calculator only works for 2023! Look out for newer or previous versions. You have to agree to the license and usage rules from CMS, of course.
- Extract the PPRRVU23*.csv or .xls 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 23, and ends in .csv or xls and is larger than 2MB. It will have about 17,000 CPT codes in it.
- This is the most challenging step, and it's still easy. The goal is to get the data from Federal spreadsheet into that 3rd tab in the Google sheet - you'll see the name on the tab and a note on the page itself. To do this, simply import the file into Google sheets. If you use the cut-and-paste method, Google will sometimes time out. It's more effective to import it first and move it into place. Don’t panic if it seems to freeze for a minute, it’s a lot of data.
- Go back to the first tab, "Front Page," and use the pulldown in cell E6 to choose your locale.
- Pick a Medicare Multiplier in B6 or leave it at 100%. Then, enter some CPT codes in column A. Gasp in amazement. If you
- 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.
Go crazy, tell me what you find. Let me know of any problems, mistakes, issues, discoveries!