Calculating result...
- Total payment
- $
- Total RVU
- RVU
- Matched codes
- codes
- Missing codes
- codes
- Services
- services
- Rows parsed
- rows
Calculation details
- Selected locality
- Selected participant type
- Conversion factor
- $ / RVU
- Selected setting
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Saved scenarios
Data source CMS 2026 · Verified 2026-08-31
- Data year
- 2026
- Version
- 2026
- Last verified
- 2026-08-31
- Source
- Imported CMS CPT/HCPCS RVU data and the national GPCI locality record.
- Data path
- Imported from the 2026 CMS-derived CPT and GPCI datasets stored in WordPress options.
- Scope
- United States Medicare payment assumptions.
- Formula
- Each matched code uses the selected locality, facility setting, and conversion factor.
Every line you paste into a bulk RVU calculator — 99213 x 8, 93000 x 20 — gets run through the same formula CMS uses to price the entire Medicare Physician Fee Schedule (MPFS): each code’s Relative Value Units are pulled from the current year’s RVU file, adjusted for locality, and multiplied by a conversion factor. Understanding what happens between “paste your codes” and “$2,696.04” is what separates someone who can read a remittance advice from someone who can actually audit one.
What a Total RVU Represents
Every CPT/HCPCS code that Medicare prices under the MPFS carries three separate RVU components, not one single number:
- Work RVU (wRVU) — physician time, skill, mental effort, and judgment.
- Practice Expense RVU (peRVU) — clinical staff, supplies, equipment, and overhead; this splits into a facility rate (lower, since the hospital absorbs some overhead) and a non-facility rate (higher, since the physician’s own office covers it).
- Malpractice RVU (mpRVU) — professional liability insurance cost, the smallest of the three, averaging roughly 4% of total RVUs across all services.
These three components sum to the Total RVU for that code, and Total RVU is what a bulk calculator reports alongside payment. For CPT 93000 (routine 12-lead EKG with interpretation and report), the 2026 non-facility breakdown is wRVU 0.17 + peRVU 0.27 + mpRVU 0.02 = 0.46 total RVU. For a mid-level established-patient office visit like 99213, CMS’s 2026 values are wRVU 1.30 and mpRVU 0.10, with the remaining practice-expense component bringing the total to 2.85. A higher-complexity 99214 visit carries a total RVU of 4.06, up from 3.87 in 2025.
GPCI and Why “National” Skips a Step
In a real claim, each RVU component gets multiplied by a Geographic Practice Cost Index (GPCI) before conversion to dollars:
\(\text{Payment} = [(wRVU \times wGPCI) + (peRVU \times peGPCI) + (mpRVU \times mpGPCI)] \times CF\)
GPCIs exist because labor, rent, and malpractice premiums vary enormously by locality — the work GPCI floor is 1.000 nationally with a 1.500 floor in Alaska, while malpractice GPCIs range from roughly 0.30 in low-litigation states to over 2.5 in high-litigation markets like Miami. Selecting “National: National Average” in a bulk calculator effectively sets all three GPCIs to 1.0, which is why the RVU-to-dollar math simplifies to Total RVU × Conversion Factor with no geographic adjustment layered in. This is useful for quick estimating or comparing code sets on an apples-to-apples basis, but it will not match your actual Medicare remittance if your practice sits in a locality with GPCIs above or below 1.0 — for a precise local estimate you’d swap the national locality for your specific MAC locality.
The Two 2026 Conversion Factors
Starting in CY 2026, CMS is legally required to publish two separate conversion factors rather than one, a change driven by the statutory split between Qualifying APM Participants (QPs) and everyone else, layered on top of a temporary 2.5% payment bump from the One Big Beautiful Bill Act and a 0.49% budget-neutrality adjustment: acc
| Participant type | 2026 conversion factor | Change vs. 2025 |
|---|---|---|
| Qualifying APM Participant (QP) | $33.5675 | +3.77% |
| Non-QP (most practices) | $33.4009 | +3.26% |
Selecting “non-qpp” as the participant type — the default for the large majority of practices that aren’t in an Advanced Alternative Payment Model — locks in the $33.4009 factor. Picking the wrong participant type is a common source of estimate errors, since the two factors differ by roughly 50 cents per RVU, which compounds fast across high-volume code sets.
Working the Example Line by Line
Take the exact input set: 99213 x8, 99214 x12, 93000 x20, national locality, non-QP conversion factor of $33.4009.
| CPT code | Total RVU (2026, national) | Qty | RVU subtotal | Payment per unit | Payment subtotal |
|---|---|---|---|---|---|
| 99213 | 2.85 | 8 | 22.80 | $95.19 | $761.52 |
| 99214 | 4.06 | 12 | 48.72 | $135.61 | $1,627.32 |
| 93000 | 0.46 | 20 | 9.20 | $15.36 | $307.20 |
| Total | 40 services | 80.72 | $2,696.04 |
Each per-unit payment is simply Total RVU × $33.4009 (with CMS rounding published rates to the cent), and each RVU subtotal is Total RVU × quantity. Summing across all three rows reproduces both headline outputs — 80.72 total RVU and $2,696.04 total payment — exactly, which is the arithmetic a bulk calculator is running silently behind every parsed line.
Reading Matched, Missing, and Rows Parsed
“Rows parsed” (3) simply counts distinct input lines regardless of quantity, while “Services” (40) sums the quantities across those lines — this distinction matters when auditing a batch of superbills, since a single line like 99214 x12 represents twelve encounters compressed into one row. “Matched codes” versus “Missing codes” flags whether each code exists in the loaded RVU file for the selected year: a code returns as missing if it’s a Category III/temporary code without an assigned RVU, a bundled add-on that CMS doesn’t separately price, a code retired or renumbered for the current cycle, or simply a typo (e.g., transposing digits in a five-digit CPT code). Coders reconciling charge tickets against expected reimbursement should treat any “missing” result as a flag to verify the code against the current CPT/HCPCS code set before assuming a bundling or payment issue on the payer side.
Practical Uses Beyond a Single Estimate
Running a bulk list like this is most valuable for scenario-testing rather than one-off lookups: comparing a clinic’s typical daily code mix against the QP versus non-QP conversion factor to quantify the dollar impact of APM participation, projecting monthly RVU volume for productivity-based compensation models tied to work RVUs specifically (not total RVUs), or stress-testing how a proposed change in visit-level mix — shifting a portion of 99213s to 99214s, for instance — moves total reimbursement before it shows up in an actual A/R report. Because the underlying RVU file updates annually with each CMS Final Rule, and mid-year corrections do occasionally occur, any bulk projection used for budgeting or compensation planning should be re-run whenever CMS publishes updated RVU or GPCI files rather than treated as a static reference.