2019 The Essential RBRVS Data File
The Essential RBRVS gives you all the codes valued by CMS, as well as relative values for many codes not valued for Medicare. The RBRVS for the Medicare physician fee schedule (MPFS) is used to set physician fees by Medicare and many commercial payers. However, the RBRVS does not provide a complete schedule. Codes not valued for Medicare are referred to as “gap” codes. The Essential RBRVS provides Medicare values and “gap” values to enable you to develop a more complete fee schedule.
- Optum360 Edge - Gap values for complete fee schedule development. Relative values for many codes not valued by CMS for the Medicare Physician Fee Schedule.
- Includes the same data relied on by over 70 percent of commercial payers. Negotiate stronger managed care contracts.
- Medicare payment indicators included. Global days, multiple procedure reduction, assistant surgery, pre-op, intra-op and post-op percentages, OPPS cap and other indicators commonly used for Medicare and commercial claims.
- Organized by CPT® and HCPCS codes. Consistently value services and procedures from different code sets.
- Total values and components for each code—including work, malpractice, practice expense and total RVUs. Evaluate the cost and productivity associated with a service, providing a more complete picture of your reimbursement.
CPT is a registered trademark of the American Medical Association.
Ms. Hall is a new product subject matter expert for Optum360. Ms. Hall has more than 25 years of experience in the health care field. Her experience includes 10 years as office manager for large multi-specialty medical practices. Ms. Hall has written several multi-specialty newsletters and coding and reimbursement manuals, and served as a health care consultant. She has taught seminars on CPT®/HCPCS and ICD-9-CM coding and physician fee schedules. She is an active member of the American Academy of Professional Coders.