Outpatient Facility Coding Alert - 2011 Issue 17
Reader Questions: No RVUs May Mean No Pay for You
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Article Overview
This reader Q&A discusses Medicare Physician Fee Schedule RVU assignment at a high level, including how to interpret fee schedule status indicators and why some CPT procedure codes may not have standard Medicare valuation. It is intended for coders, billers, and revenue cycle staff who need to understand payment status, carrier-priced services, and the role of secondary payers when Medicare payment is uncertain or unavailable. The article also references how to look up fee schedule information and compare payer policies without going into detailed coding methodology.
Why This Topic Matters
Understanding why a code has no RVUs helps billing teams anticipate whether Medicare will reimburse a service, whether payment may depend on a contractor, and whether another payer might cover it. This affects claim follow-up, charge capture, and payment expectations for practices that bill Medicare and other insurers.
Article Sections
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Question
A reader asks about procedure codes that do not appear with RVUs and how to locate RVU information in the Medicare fee schedule.
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Answer
The response explains the general relationship between RVUs, Medicare fee schedule pricing, and payment status for certain procedure codes.
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Key
This section describes how fee schedule status indicators are reviewed and how payment responsibility may vary by contractor or payer policy.
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Options
The article closes with a brief discussion of secondary payer review when Medicare payment is unavailable or limited.
What You Will Learn
- How Medicare fee schedule pricing relates to RVU availability
- How fee schedule status indicators help identify payment status
- How contractor-level pricing may differ from standard Medicare valuation
- Why secondary payer review can matter when Medicare does not pay
Who Should Read This
- Medical coders
- Medical billers
- Revenue cycle staff
- Practice managers
- Ophthalmology billing staff
Codes Discussed
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