Comparing RVUs across new patient visit codes only produces a usable answer when the CPT code, site of service, GPCI locality, and conversion factor year are held constant across every code you’re comparing. Change any one of those four inputs and you’re no longer comparing the same thing — you’re comparing a new patient visit in one locality against a different service, setting, or payment year, which is not a valid RVU comparison at all.
New patient office and outpatient visits are billed under CPT codes 99202 through 99205 (99201 was deleted in 2021). Each level reflects a different amount of physician work and, correspondingly, a different work RVU (wRVU) — the RVU component that carries the most weight in most physician compensation plans. But wRVU alone does not tell you what Medicare pays, and it does not tell you what a physician is compensated. Those are three separate numbers that share one input.
The New Patient CPT Code Family
Confirming the correct code is a coding decision, not an RVU decision — it depends on medical decision-making level or total time, documentation, and payer-specific E/M guidelines. Once a code is selected, the RVU components attached to it are fixed by CMS for a given calendar year and can be compared directly against the RVU components of adjacent codes in the same family.
| CPT Code | Visit Level | Work RVU (reference) | Total RVU (non-facility, reference) |
|---|---|---|---|
| 99202 | New patient, straightforward MDM | ~0.93 | ~2.20 |
| 99203 | New patient, low MDM | ~1.60 | ~3.52 |
| 99204 | New patient, moderate MDM | ~2.60 | ~5.31 |
| 99205 | New patient, high MDM | ~3.50 | ~7.06 |
These figures are illustrative reference points drawn from published CPT RVU data and are consistent with values that have been broadly stable since the 2021 E/M overhaul. Because RVU values, practice expense inputs, and Conversion Factors can shift with each CMS rulemaking cycle, always confirm the exact work RVU, non-facility PE RVU, facility PE RVU, and malpractice RVU for the current year using the CMS Physician Fee Schedule Look-Up Tool or the equivalent imported dataset behind the RVU calculator before using a number in a payment or compensation model.
What Each RVU Component Actually Measures
Every CPT and HCPCS code under the Medicare Physician Fee Schedule (MPFS) carries three separate RVU components, and conflating them is one of the most common errors in RVU discussions.
| Component | What it represents | Where it’s used |
|---|---|---|
| Work RVU (wRVU) | Physician time, skill, mental effort, and judgment for the service | Core input for most physician compensation formulas |
| Practice Expense RVU (PE RVU) | Overhead: staff, equipment, supplies, clinical space — different for facility vs. non-facility settings | Medicare payment calculation only; rarely used in compensation |
| Malpractice RVU (MP RVU) | Cost of professional liability insurance associated with the service | Medicare payment calculation only |
Total RVU = Work RVU + Practice Expense RVU + Malpractice RVU. Total RVU, not work RVU alone, is the number that feeds into a Medicare payment calculation. This distinction matters specifically for new patient visits because the non-facility PE RVU (physician office) and facility PE RVU (hospital outpatient, for example) differ meaningfully for the same code — a 99204 billed in a physician’s own office carries a higher PE RVU than the same code billed in a facility setting, since CMS assumes the facility absorbs more of the overhead.
From RVU to Medicare Payment
Medicare does not pay a fixed dollar amount per RVU nationwide. Payment depends on geographic cost adjustment and the annual Conversion Factor:
\(\text{Medicare Payment} = \left((\text{Work RVU} \times \text{Work GPCI}) + (\text{PE RVU} \times \text{PE GPCI}) + (\text{MP RVU} \times \text{MP GPCI})\right) \times \text{Conversion Factor}\)
The Geographic Practice Cost Index (GPCI) exists because the cost of running a practice — rent, wages, malpractice premiums — varies by locality. A GPCI of 1.000 represents the national average; localities with higher costs of practice (e.g., major metro areas) carry GPCI values above 1.000, and lower-cost areas fall below it. This is why the identical CPT code, with identical RVU components, produces different Medicare payment amounts depending on where the service is furnished — a fact that trips up many first-time RVU calculator users who expect one universal payment per code.
The Conversion Factor (CF) is the dollar multiplier CMS sets each year to translate GPCI-adjusted RVUs into a payment amount. Starting in CY2026, CMS finalized two separate conversion factors for the first time: $33.5675 for clinicians who are Qualifying Participants (QPs) in an Advanced Alternative Payment Model, and $33.4009 for non-QP clinicians billing under MIPS — both up from the CY2025 CF of $32.3465, reflecting a statutory update plus a work RVU budget-neutrality adjustment. Which CF applies to a given claim depends on the billing clinician’s QPP participation status, not on the CPT code itself.
Worked Example
Using national-average GPCI values (1.000 for all three components, for illustration only) and the CY2026 non-QP Conversion Factor of $33.4009:
- 99203, non-facility total RVU ≈ 3.52 → 3.52 × $33.4009 ≈ $117.57
- 99204, non-facility total RVU ≈ 5.31 → 5.31 × $33.4009 ≈ $177.36
This is an illustrative national-average calculation, not a locality-specific allowed amount. Real claims apply the actual GPCI values for the rendering locality, which almost always differ from 1.000, and the actual Total RVU figures published in that year’s MPFS file. For a locality-specific figure, the RVU calculator with the imported CMS 2026 RVU file and locality selector is the correct tool — a manual formula walkthrough is meant to explain the mechanism, not replace it.
wRVU-Based Compensation Is a Different Calculation Entirely
This is where new patient visit RVU comparisons are most often misapplied. Many employed physicians are compensated on a wRVU-based model, where the employer sets an internal dollar rate per work RVU (a “conversion rate”) that is negotiated in the employment agreement — it has no fixed relationship to the Medicare Conversion Factor.
\(\text{Estimated Compensation} = \text{Work RVU} \times \text{Contracted Rate per wRVU}\)
For example, if an employment agreement sets a compensation rate of $55 per wRVU (an illustrative example, not a market benchmark), a physician billing a 99204 (work RVU ≈ 2.60) would generate approximately $143 in wRVU-based compensation credit for that visit — a number that has no fixed arithmetic relationship to the $177.36 Medicare payment estimate above, because one reflects negotiated compensation economics and the other reflects a federal payment formula built on total RVU, GPCI, and CF. Comparing new patient visit codes for productivity purposes should stop at work RVU and move into the compensation agreement; comparing the same codes for reimbursement purposes requires total RVU, GPCI, and the applicable Conversion Factor. Running both through the same number produces a compensation estimate that looks like a Medicare payment estimate, which is a frequent and avoidable error.
Why Adjacent New Patient Codes Differ
The RVU gap between 99202 and 99205 is not arbitrary — it reflects CMS’s valuation of increasing medical decision-making complexity and, since 2021, total time thresholds as an alternative basis for code selection. From an RVU standpoint, three things typically move together as the level increases:
- Work RVU increases to reflect more cognitive effort and risk.
- Non-facility PE RVU increases modestly, reflecting more staff and resource time per visit.
- Malpractice RVU increases slightly, tracking the higher-acuity risk profile of the encounter.
None of this determines which code should be billed for an actual encounter — that depends on documented MDM elements, total time, and payer-specific E/M audit criteria, which sit outside RVU analysis entirely.
Running the Comparison in Practice
The sequence that keeps a new patient visit RVU comparison valid is straightforward:
- Confirm the CPT code through the coding workflow — not through RVU output.
- Open the CPT-specific data page (for example, the CPT 99203 RVU guide or the CPT 99204 RVU guide) to confirm the current year’s work RVU, PE RVU, and MP RVU.
- Select the same site of service (facility or non-facility) for every code being compared.
- Apply the same GPCI locality to every code — mixing localities invalidates the comparison.
- Confirm which Conversion Factor applies (QP vs. non-QP) before finalizing a payment estimate.
- If the goal is productivity or compensation, stop at work RVU and route the number through the employment agreement’s per-wRVU rate rather than the Medicare Conversion Factor.
What This Comparison Does Not Decide
An RVU comparison across 99202–99205 explains payment and productivity mechanics; it does not decide which code applies to a specific encounter. Code selection depends on documentation, MDM or time criteria, modifiers, and payer policy — all of which belong to the coding review process, not the RVU calculation. Similarly, a Medicare payment estimate is not a payer-specific allowed amount, since commercial payers frequently use their own fee schedules or a percentage of Medicare rather than the MPFS directly, and a wRVU-based compensation figure is not a substitute for reviewing the actual written compensation agreement, which may include thresholds, quality withholds, or other adjustments beyond a flat per-wRVU rate.
The most reliable way to use this comparison is to keep the four inputs — CPT code, setting, GPCI locality, and Conversion Factor year — visible at every step, and to treat any final number as tied to those specific assumptions rather than as a permanent rate for the code itself.