The Centers for Medicare & Medicaid Services released the 2011 Resource-Based Relative Value Scale (RBRVS) final rule in November 2010.

The Medicare CF for 2011 is $33.9764.

To demonstrate various methods that can be used to calculate Medicare payment, CPT code 99213 (office/outpatient evaluation and management visit, established patient) will be used as an example. For this example, it is assumed that a participating provider in an office setting in suburban Chicago, IL, provides services in 2011.

For CPT code 99213, the total non-facility RVU is 2.03.

Following are several methods that can be used to calculate Medicare payments. Methods 1 and 3 are the simplest because GPCIs are not applicable.

Note that some payers will not use Medicare RVUs but may instead apply their own relative values. Most payers use their own CF.

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