Welcome to the free 2019 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 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.
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.
What would you use this for? Many things!
- You want to make sure your pricing is logical and supportable. Enter your fees and see where you don't line up.
- You want to compare your pricing to another pricing set - a fee schedule, perhaps, or another practice.
- 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.
- 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 2019 RVU Calculator.
- Head to CMS and download the latest 2019 RVU zip file. This link can bring you to the list of RVU files CMS hosts - but this calculator only works for 2019! Look out for newer versions. You have to agree to the license and usage rules from CMS, of course.
- Extract the PPRRVU19*.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 19, and ends in .csv and is larger than 2MB. It will have just under 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.
- Cut and paste the entire page of data from the PPRRVU19*.csv file into the tab marked “PPRRVU19_JAN.csv″ in the RVU Calculator spreadsheet. Don’t panic if it seems to freeze for a minute, it’s a lot of data.
- Go to the middle tab, "GPCI19." 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 B6. It should overwrite the Name and 3 GPCI value fields.
- Pick a Medicare Multiplier in B8 or leave it at 175%. Then, enter some CPT codes in column A. Gasp in amazement.
- Put some unit volumes, prices, and payments in and watch what happens.
Note that any field in light green is one where you are expected to add your own information.
New in from versions before 2018:
- The GPCI identification method has changed. It was too time consuming to make 2 different version of the tool (one for LibreOffice, which was easy, and one for Excel, which was not), so I've created one that should work on both. It takes 10 more seconds to use at the start, but that's it.
- I cleaned up some of the visuals to make it easier to read.
- There's a new calculation in B10 - Payment FACF. This lets you know what your payments are, overall, when compared to Medicare.
- I added many additional lines for analysis.
- We've changed the suggestion for RVU import to use the CSV file instead of the XLSX file because Excel doesn't do lookup matching well otherwise.
Go crazy, tell me what you found.