Total RVU and work RVU in Pain Management and PM&R Clinics for 2014

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The Pain Source RVU numbers logoBelow is a list of the most common CPT codes (procedure codes) and there assigned relative value units (RVU) and work RVU used in a PM&R and interventional pain management clinic.   These have all been updated for the 2014 changes from the Centers for Medicare and Medicaid Services (CMS).  The data below is compiled from this CMS website.

Here is also a great collection of most CMS (Medicare) pain & spine physician payment rates for 2015 (compiled by ASIPP – American Society of Interventional Pain Physicians).  Link

Here is a PDF version of the below table

 

 

2014 CPT and RVU numbers

CPT code

Description

Work RVU

Total RVU

99201

 Office/outpatient visit new

0.48

1.21

99202

 Office/outpatient visit new

0.93

2.08

99203

 Office/outpatient visit new

1.42

3.02

99204

 Office/outpatient visit new

2.43

4.64

99205

 Office/outpatient visit new

3.17

5.78

99211

 Office/outpatient visit established

0.18

0.56

99212

 Office/outpatient visit established

0.48

1.22

99213

 Office/outpatient visit established

0.97

2.04

99214

 Office/outpatient visit established

1.5

3.01

99215

 Office/outpatient visit established

2.11

4.03

99241

 Office consultation

0.64

1.37

99242

 Office consultation

1.34

2.57

99243

 Office consultation

1.88

3.51

99244

 Office consultation

3.02

5.19

99245

 Office consultation

3.77

6.35

Joints / Bursa / Muscle / Nerve / Other

20526

 Carpal tunnel

0.94

2.15

20550

 Tendon sheath or ligament

0.75

1.65

20551

 Tendon origin/insertion

0.75

1.71

20552

 Trigger point, 1-2 muscles

0.66

1.56

20553

 Trigger point, 3+ muscles

0.75

1.80

96372

 Injection – intramuscular

0.17

0.70

20600

 Minor joint/bursa

0.66

1.35

20605

 Intermediate joint/bursa

0.68

1.41

20610

 Major joint/bursa

0.79

1.70

27096

 SIJ with fluoro

1.48

4.61

20552

 SIJ without fluoro

0.66

1.56

64450

 Other peripheral nerve

0.75

2.26

64640

 RFA – Sacral lateral branches

1.23

3.78

64420

 Intercostal nerve (single)

1.18

3.20

64421

 Intercostal nerve (multiple)

1.68

4.34

64510

 Stellate ganglion

1.22

3.60

64520

 Sympathetic T/L

1.35

5.42

64530

 Celiac plexus

1.58

5.42

64405

 Greater occipital block

0.94

2.85

77002

 Fluoroscopy – non-spinal

0.54

2.88

77003

 Fluoroscopy – spinal

0.6

2.54

Spinal Cord Stimulator

63650

 SCS trial

7.15

37.67

63685

 SCS pulse generator implant

5.19

10.42

63661

 SCS lead removal

5.08

16.31

Botox Injections

95874

 Needle EMG during chemodenervation

0.37

2.02

64616

 Chemodenervation for neck

1.53

3.48

64615

 Chemodenervation for face (migraines)

1.85

4.07

64642

 Chemodenervation 1 extremity 1-4 ms

1.65

3.95

64643

 each additional extremity, 1-4 ms 

1.22

2.60

64644

 Chemodenervation, 1 extrem., 5+ ms

1.82

4.51

64645

 each additional extremity, 5+ ms

1.39

3.18

Kyphoplasty

22523

 Kypho (thoracic) 1st level

9.04

209.01

22524

 Kypho (lumbar) 1st level

8.54

207.14

22525

 Each additional level

4.47

126.67

72291

 Fluoroscopic guidance for kypho

1.31

2.05

Vertebroplasty

22520

 Vertebroplasty (thoracic) 1st level

9.22

63.37

22521

 Vertebroplasty (lumbar) 1st level

8.65

63.45

22522

 Vertebroplasty – each additional level

4.30

6.48

72291

 Fluoroscopic guidance for vertebro.

1.31

2.05

Discograms

62291

 Discogram – cervical/thoracic

2.91

9.16

62290

 Discogram – lumbar

3

9.51

72285

 Supervison fluoro for disco (C/T)

1.16

3.26

72295

 Supervison fluoro for disco (Lumbar)

0.83

2.82

Epidurals

62310

 IL ESI C/T

1.18

3.09

62311

 IL ESI L/S

1.17

3.04

64479

 TF ESI C/T first

2.29

6.82

64480

 TF ESI C/T each additional

1.2

3.27

64483

 TF ESI L/S first

1.9

6.29

64484

 TF ESI L/S each additional

1

2.50

62273

 Epidural blood patch

2.15

4.93

Facet (Zygapophysial joint)

64490

 Facet – C/T first

1.82

5.48

64491

 Facet – C/T second

1.16

2.69

64492

 Facet – C/T third & additional

1.16

2.71

64493

 Facet – L/S first

1.52

4.95

64494

 Facet – L/S second

1

2.47

64495

 Facet – L/S third & additional

1

2.48

64633

 RFA – C/T 1st joint

3.84

12.30

64634

 RFA – C/T each additional

1.32

5.58

64635

 RFA – L/S 1st joint

3.78

12.13

64636

 RFA – L/S each additional

1.16

5.04

Electrodiagnostics (EMG/NCS)

95831

 MMT (no hand)

0.28

0.77

95832

 MMT hands

0.29

0.71

95860

 1 extremity w or w/o paraspinal areas

0.96

3.40

95861

 2 extremities

1.54

4.71

95863

 3 extremities

1.87

5.73

95864

 4 extremities

1.99

6.60

95867

 Unilateral cranial nerve muscles

0.79

2.62

95868

 Bilateral cranial nerve muscles

1.18

3.65

95869

 Thoracic paraspinal muscles

0.37

2.11

95874

 Guidance with Botox

0.37

2.02

95885

 Limited 4 or fewer muscles

0.35

1.64

95886

 Complete 5+ muscles

0.86

2.57

95907

 1-2 studies

1

2.66

95908

 3-4 studies

1.25

3.28

95909

 5-6 studies

1.5

3.95

95910

 7-8 studies

2

5.19

95911

 9-10 studies

2.5

6.31

95912

 11-12 studies

3

7.42

95913

 13+ studies

3.56

8.59

12 COMMENTS

  1. Hi, I have a question about recent change in CMS billing.

    I work for a hospital, therefore I get paid through wRVU.

    I noticed that when I do lumbar RFA on bilateral level, I actually only get credit for unilateral level. is this true with the new change?

    For example: i do a bilateral L3,4,5 RFA.
    I billed 64635, 64635 -mod 50, 64636, 64636 – mod 50.

    When i get my wRVU report, i only get credit for
    64635 and 64636 (half of what I billed for).

    I would like to know if I’m missing anything here.

    Thank you,

    • Michael, this is likely because most insurances I have come across only allow RF to 3 levels at one time. Since you’re billing for essentially four facets, your hospital is only billing for the two on one side and writing off the others. Better to just do the L4/5 and L5/S1 facets on one side one week, then the other side the next week. It sucks for our patients, but it’s all dictated by the insurance companies, so I just blame them.

  2. Question about the new CMS changes:

    We’re getting denials with billing
    62311 and 77003,26

    The denial I’m getting from Medicare is that the modifier 26 is not the correct one, and I’ve looked all over and I can’t find which modifier is appropriate.

  3. In reference to the above question, will the same situation apply for diagnostic medial branch nerve block also, i have been doing diagnostic blocks as bilateral procedure while RFA one side at a time. Any response is appreciated

  4. I am looking for information based on RVUs. What are some salary averages…25%,50%,75% for pain docs (PM&R and Anesthesia) with RVU codes associated with such salary. I cannot find good information out there unless I pay for MGMA survey results. Any help would be great.

  5. Do you use the 95831 and 95832 codes in addition to your EMG codes. For example if you were to see a patient for EMG studies but prior to these examined muscle strength to ensure you were doing the right studies could you code for these (95831/95832) as well.

    • In simple terms, a work RVU is considered the work done by the physician, whereas the total RVU is the revenue needed to pay a facility for everything (the physician work/time, the meds needed, the equipment and other staff needed, etc).

  7. Chris, how do the RVUs differ from the “base units” in the ASA relative value guide (RVG)? For example: an SI with fluoro is 9 units in the RVG and 4.61 here. Am I missing something?

    • Sorry Dr. G. My compensation isn’t based on work RVU now so I haven’t taken the time to update this information since 2014. Since then, SIJ injection has been bundled with the fluoro, so that may be why your numbers are different.

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