Work RVU
A work RVU measures the time, skill, effort, and intensity a physician puts into a service, relative to other services. It is the first of the three RVU compone...
Practice expense RVU
The practice expense RVU reflects the overhead cost of a service: clinical staff time, supplies, equipment, and indirect costs such as rent and administration....
Malpractice RVU
The malpractice RVU reflects the relative cost of professional liability insurance for a service. It is usually the smallest of the three RVU components, and it...
GPCI
A GPCI is a geographic index that scales an RVU component up or down to reflect local costs. Medicare publishes three GPCIs for each payment locality—one each f...
Payment locality
A payment locality is the geographic area Medicare uses to set local cost adjustments under the Physician Fee Schedule. Each locality is identified by a Medicar...
Conversion factor
The conversion factor is the dollar multiplier that turns a code's geographically adjusted RVUs into a payment amount. CMS updates it at least once a year. Star...
Status indicator
A status indicator is the one-letter code that tells you how Medicare treats a service under the Physician Fee Schedule: separately payable, bundled into anothe...
HCPCS
HCPCS is the code set Medicare uses to identify procedures, services, supplies, and drugs. It has two levels: Level I is the CPT code set, and Level II is a set...
CPT
CPT is the code set used to report medical procedures and services. The American Medical Association maintains it, and it forms Level I of HCPCS. Most physician...
NCCI PTP edit
An NCCI procedure-to-procedure (PTP) edit is a CMS rule pairing two HCPCS/CPT codes that should not normally both be paid when a provider reports them for the s...
MUE
A Medically Unlikely Edit (MUE) is the maximum number of units of a HCPCS/CPT code that one provider reports for one patient on one date of service on the vast...
OPPS cap
The OPPS cap limits Physician Fee Schedule payment for the technical component of certain diagnostic imaging services to what Medicare's Hospital Outpatient Pro...
Anesthesia base units
Anesthesia services (status J) are not priced with the standard work, practice expense, and malpractice RVU formula. Medicare pays base units plus time units, m...
Limiting charge
The limiting charge is the most a non-participating provider can bill a Medicare patient for a service when not accepting assignment: 115% of the non-participat...
Bilateral surgery indicator
The bilateral surgery indicator tells you how Medicare adjusts payment when a procedure is performed on both sides of the body, usually billed with modifier 50....
Assistant at surgery indicator
The assistant at surgery indicator is a per-procedure flag in the Medicare Physician Fee Schedule showing whether Medicare's payment restriction on assistants a...
Co-surgeon indicator
The co-surgeon indicator tells you whether two surgeons, each in a different specialty, can each be paid for performing distinct parts of the same procedure, bi...
Team surgery indicator
The team surgery indicator tells you whether Medicare pays a surgical team—several physicians, often of different specialties, billed with modifier 66—for a pro...
Multiple procedure indicator
The multiple procedure indicator tells you how Medicare reduces payment when a procedure is billed with other procedures for the same patient on the same day—th...
PC/TC indicator
The PC/TC indicator tells you whether a code splits into a professional component (the physician's interpretation, billed with modifier 26) and a technical comp...
NP and PA payment
When a nurse practitioner (NP), physician assistant (PA), or clinical nurse specialist (CNS) bills Medicare under their own NPI, the allowed amount is 85% of wh...
Global surgery period
A global surgery period is the window of related care a procedure’s fee already pays for. CMS gives every code a value in the RVU file: 000 covers the day of th...
For longer-form walkthroughs of how these pieces fit together, browse the guides—or see a rate computed end-to-end in the expected-payment calculator.