RVU Calculator

A QP is a Medicare clinician who participates in an Advanced Alternative Payment Model (Advanced APM) and meets CMS thresholds for the share of patients and/or payments that flow through that APM. QPs are exempt from MIPS penalties and instead receive more favorable Medicare payments, which from 2026 onward are implemented as a higher conversion factor on the Physician Fee Schedule compared with non‑QP peers.

A non‑QP is any Medicare clinician who does not meet those QP thresholds, even if they participate in some value‑based programs. non‑QPs are paid under the standard Physician Fee Schedule conversion factor and remain subject to MIPS performance-based adjustments, rather than the enhanced QP payment stream.

Represents the physician's work and effort required to provide the service, including time, technical skill, physical effort, mental effort, and judgment.

Reflects the cost of office staff, supplies, equipment, and facility costs required to deliver the service. Varies by place of service (facility vs. non-facility).

Accounts for professional liability insurance costs associated with performing the service, including malpractice risk and claims history.

Sum of Work RVU, Practice Expense RVU, and Malpractice RVU. This is the total relative value before converting to dollar amounts.

Adjusts RVU values based on geographic location to account for regional differences in practice costs, staffing costs, and market conditions. Values above 1.0 indicate higher costs; below 1.0 indicate lower costs.

A dollar multiplier set annually by CMS that converts total RVU into actual payment. Multiply Total RVU × CF to determine Medicare allowed reimbursement.

The final Medicare reimbursement amount. Calculated as: (Total RVU × GPCI adjustments) × Conversion Factor. This is what the provider is allowed to bill and receive from Medicare.

Only the physician's professional work is billed. Equipment/facility costs are billed separately under modifier TC. This payment is the professional component share only.

Only equipment, facility, and staff costs are billed. The physician's professional fee is billed separately under modifier 26. This payment is the technical component share only.

Both sides (left and right) of the body are treated in a single session. Payment shown is 150% of the standard single-side fee for both sides combined.

Additional procedures in the same session typically receive 50% payment reduction. Primary procedure pays 100%, subsequent procedures at 50%.

Two physicians of different specialties each performed distinct parts of the same procedure. Each surgeon receives 62.5% of the standard surgical fee. Each surgeon files this separately.

A physician acted as an assistant surgeon. Payment shown is 16% of the standard surgical fee. The primary surgeon receives their full payment separately.

A Physician Assistant or Nurse Practitioner acted as an assistant surgeon. Payment shown is 13.6% of the standard surgical fee. The primary surgeon receives their full payment separately.