Fee Schedule Calculations

Physician Fee Schedule Amount Calculation

Physician Fee Schedule Variables

Variables	Descriptions
\(RVU_w\)	Relative Value Unit (Physician Work)
\(GPCI_w\)	Geographic Practice Cost Index (Physician Work)
\(RVU_p\)	Relative Value Unit (Practice Expense)
\(GPCI_p\)	Geographic Practice Cost Index (Practice Expense)
\(RVU_m\)	Relative Value Unit (Malpractice)
\(GPCI_m\)	Geographic Practice Cost Index (Malpractice)
\(CF\)	Conversion Factor

Physician Fee Schedule Formulas

Formula	Result
\(RVU_w(GPCI_w) + RVU_p(GPCI_p) + RVU_m(GPCI_m)\)	Total RVUs
\(\text{Total RVUs} \times CF\)	Participating Fee
\(\text{Participating Fee} \times 0.95\)	Non-Participating Fee
\(\text{Participating Fee} \times 1.0925\)	Limiting Charge

As there is a corresponding GPCI value for each of the three components of an RVU, the formula is essentially the dot product of the RVU and GPCI vectors, multiplied by the Conversion Factor:

\[ RVU \cdot GPCI = RVU_w(GPCI_w) + RVU_p(GPCI_p) + RVU_m(GPCI_m) \]

wrvu  = 6.26   # Work RVU
wgpci = 1      # Work GPCI

pgpci = 0.883  # Practice GPCI
prvu  = 4.36   # Practice RVU

mrvu  = 0.99   # Malpractice RVU
mgpci = 1.125  # Malpractice GPCI

cf    = 32.744 # Conversion Factor

rvus <- (wrvu * wgpci) + (prvu * pgpci) + (mrvu * mgpci)
rvus # Total RVUs

#> [1] 11.22363

rvus * cf # Participating Fee

#> [1] 367.5065

Using base r’s matrix multiplication infix operator

as.vector(c(wrvu, prvu, mrvu) %*% c(wgpci, pgpci, mgpci))

#> [1] 11.22363

Using the dot() function from the {pracma} package

pracma::dot(
  c(wrvu, prvu, mrvu), 
  c(wgpci, pgpci, mgpci))

#> [1] 11.22363

calculate_amounts(
  wrvu  = 6.26,
  nprvu = 7.92,
  fprvu = 4.36,
  mrvu  = 0.99,
  cf    = 32.744,
  wgpci = 1,
  pgpci = 0.883,
  mgpci = 1.125) |> 
  tt() |> 
  format_tt(markdown = TRUE) |> 
  style_tt(bootstrap_class = "table table-hover")

component	value
facility_prvu	4.36000
facility_rvu	11.22363
facility_par	367.50654
facility_nonpar	349.13121
facility_limit	401.50090
nonfacility_prvu	7.92000
nonfacility_rvu	14.36711
nonfacility_par	470.43665
nonfacility_nonpar	446.91482
nonfacility_limit	513.95204