RBRVS fee schedule formula


1. Given the information below, calculate the payment for performing a repair of a nail bed (CPT code 11760) in Birmingham, Alabama. Show your work to receive credit.

The RBRVS fee schedule formula:

[(RVUw x GPCIw) + (RVUpe x GPCIpe) + (RVUm x GPCIm)] x CF = Payment
RVUw = 1.63

RVUpe = 1.91

RVUm = 0.22

GPCIw = 1.00

GPCIpe = 0.850

GPCIm = 0.617

National CF = $35.8013

Oachs, K. O. & Watters, A. L. (2016). Health Information Management Concepts, Principles, and Practice, 5th ed. Chicago, IL: American Health Information Management Association.

2. Analyze and explain the differences between fee-for-service, episode-of-care, and RBRVS payment methodologies.