How Many RVUs for CPT Code 99213?
Learn how Relative Value Units for CPT code 99213 are calculated and influence physician earnings and practice finances in the healthcare system.
Relative Value Units (RVUs) are a fundamental component of the U.S. healthcare reimbursement system. They serve as a measure of medical service value and directly influence physician payment and practice revenue.
Understanding Relative Value Units
Relative Value Units (RVUs) reflect the resources consumed when furnishing a physician service. They comprise three main components. The Work RVU (wRVU) accounts for the physician’s effort, including the time, technical skill, mental effort, and judgment.
The Practice Expense RVU (PE RVU) covers medical practice overhead costs, including staff salaries, office rent, supplies, and equipment. The Malpractice RVU (MP RVU) represents professional liability insurance costs for a service.
RVU values are determined and updated annually by the Centers for Medicare & Medicaid Services (CMS). These national values are subject to geographic adjustments, reflecting regional variations in practice costs.
RVUs for CPT Code 99213
CPT code 99213 represents an office or outpatient visit for an established patient. It typically involves low medical decision-making or 20 to 29 minutes of total time. This code is frequently used for follow-up visits, routine check-ups, and managing new symptoms.
For Calendar Year 2025, the RVU values for CPT code 99213 are: Work RVU: 1.30, Practice Expense RVU (non-facility): 1.30, and Malpractice RVU: 0.08. These values change annually; providers should consult the current Medicare Physician Fee Schedule (MPFS) for precise figures.
Calculating Physician Compensation and Practice Revenue
Total RVUs convert to a dollar payment amount using a formula that accounts for national and regional factors. Work, Practice Expense, and Malpractice RVUs are summed for a service to get the total RVU. This total RVU is then multiplied by a Conversion Factor (CF), a dollar amount set annually by CMS. For 2025, the finalized conversion factor is $32.35.
Payment amounts adjust for regional practice costs using the Geographic Practice Cost Index (GPCI). Each of the three RVU components (Work, Practice Expense, and Malpractice) has its own GPCI, ensuring payments account for regional cost variations. The formula for calculating Medicare payment is: [(Work RVU Work GPCI) + (Practice Expense RVU Practice Expense GPCI) + (Malpractice RVU Malpractice GPCI)] Conversion Factor.
For example, using 2025 non-facility RVU values for CPT code 99213 (Work: 1.30, PE: 1.30, MP: 0.08), the total RVU is 2.68. Multiplying this by the 2025 conversion factor of $32.35 results in a payment of $86.63 for this service. This payment contributes directly to a practice’s overall revenue.
Physician compensation models often utilize Work RVUs (wRVUs) as a key metric in productivity-based structures. A physician’s earnings are directly tied to the volume and complexity of services provided, measured by wRVU generation. This links individual clinical effort to financial outcomes, incentivizing efficiency and higher patient volumes.