RVU to Medicare payment
The whole formula, with every step visible: three RVUs against your three geographic indices, times the conversion factor. You supply the RVUs — CPT is licensed and we do not republish it — and the page says exactly why rather than leaving you to wonder what is missing.
The three relative value units, for the setting you are billing
Geographic practice cost indices for your locality
The conversion factor, and how many units
1.50 × 1.0001.5000
1.20 × 1.0001.2000
0.10 × 1.0000.1000
2.8000 × $33.40$93.52
The formula, in full: [(Work RVU × Work GPCI) + (PE RVU × PE GPCI) + (MP RVU × MP GPCI)] × conversion factor. With every GPCI at 1.000 this is the national figure, which is what “national average” means on any fee schedule.
About the conversion factor
It is a dollar figure per total RVU, set annually, and from CY2026 there are two — one for qualifying alternative payment model participants and one for everybody else. Summaries of the final rule published by specialty societies report $33.57 for qualifying APM participants and $33.40 for non-qualifying, against $32.35 the year before.
We could not extract those two figures from the CMS document itself — the final-rule summary PDF would not yield its text to us — so they are marked as reported rather than as verified, the field above is editable, and it is pre-filled with the non-qualifying figure because that is the commoner case. Confirm yours against the CMS look-up tool before relying on a number. A calculator that hard-coded one would also be wrong the moment it changed, and in 2024 it changed twice inside one year.
What this will not do, and why
- It will not look a CPT code up. CPT is AMA copyright and the AMA requires a licence for use or reprinting in any product or publication. Competitors who type-a-code-get-a-number either hold that licence or are taking a risk we are not.
- It does not know your locality’s GPCIs. They are published by CMS and there are over a hundred localities; the fields default to 1.000, which gives the national figure rather than a wrong local one.
- It is the Medicare allowable, not what you will be paid. Sequestration, multiple-procedure reductions, the patient’s deductible and coinsurance, and your commercial contracts expressed as a percentage of Medicare all sit between this number and the deposit.
If your commercial contracts are written as a percentage of Medicare, this figure times that percentage is your expected allowable — and the gap between it and what was actually paid is an underpayment worth working. What that queue costs.
The honest version of the most popular tool in this industry
Type a code, get a number. That is the shape of the four highest-traffic tools in medical billing, and it is the shape this one deliberately does not have. CPT is copyright of the American Medical Association, the AMA requires a licence for its use or reprinting in any product or publication, and CMS distributes its own relative-value files under that licence. A tool that turns 99214 into its RVUs is republishing licensed data.
Several competitors publish exactly that. Some of them hold the licence. We do not know which, and we are not going to find out by copying them — so this does the half that is unambiguously public, which happens to be the half nobody shows their working on. Every multiplication is on screen, so the number can be checked rather than trusted.
If the licence is worth buying, that decision belongs to somebody looking at the price of it against the traffic. Until then this is the tool we can stand behind.
Questions
How is Medicare payment calculated from RVUs?
Payment equals [(Work RVU × Work GPCI) + (Practice Expense RVU × PE GPCI) + (Malpractice RVU × MP GPCI)] × the conversion factor. The three RVUs come from the fee schedule for the setting you are billing — facility or non-facility — the three GPCIs come from your Medicare locality, and the conversion factor is a single dollar figure set annually. With every GPCI at 1.000 the result is the national figure.
What is the 2026 Medicare conversion factor?
From CY2026 there are two: summaries of the final rule published by specialty societies report $33.57 for qualifying alternative payment model participants and $33.40 for everybody else, against $32.35 the year before. We could not extract those figures from the CMS document itself, so the tool treats them as reported rather than verified, pre-fills the non-qualifying one and leaves the field editable. Confirm yours against the CMS look-up tool.
Why can I not just type a CPT code in?
Because CPT is copyright of the American Medical Association, and the AMA requires a licence for use or reprinting of CPT in any product or publication — CMS distributes its own relative-value files under an AMA licence agreement. A tool that turns a code into its RVUs is republishing licensed data. Take the three values from your own practice-management system or the free CMS look-up tool and this does the arithmetic.
Is the answer what I will actually be paid?
No — it is the Medicare allowable. Sequestration, multiple-procedure reductions, the patient’s deductible and coinsurance and your own commercial contracts all sit between that figure and the deposit. If a commercial contract is written as a percentage of Medicare, this number times that percentage is your expected allowable, and the gap against what was paid is an underpayment worth working.
The gap between the allowable and the deposit is the job
Underpayments against a contracted percentage of Medicare are the quietest money a practice loses — nobody denies the claim, it just pays short. A seat works that queue line by line, full time, on your hours, inside your own system.
Nothing you typed into the tool above is attached to this. This form sends the three fields in it and which page it came from — that is all it can send. Or write to ops@softhomeglobal.com and skip the form entirely. What happens to it.
Next step
Twenty minutes is enough to tell whether this fits
If it does not, I will say so. There is no sequence and nobody chases you.
Or write to ops@softhomeglobal.com