Remember, the calculation to find the Medicare Allowable Fee for a specific service is as follows:

[(RVUw x GPCIw) + (RVUpe x GPCIpe) + (RVUmp x GPCImp)] x CF = Medicare Allowable Fee

Let's start with a practice question. I will walk you through this first one!

Practice Question: How much is the Medicare Allowable Fee for an office visit for a new patient with a detailed history, a detailed exam and medical decision making of low complexity (99203) for a physician in St. Louis? Use a conversion factor of $34.8931. Again, the calculation is:

[(RVUw x GPCIw) + (RVUpe x GPCIpe) + (RVUmp x GPCImp)] x CF = Medicare Allowable Fee

Billing 99203 in St. Louis:

• • 1.60 (RVUw) x 1.000 (GPCIw) = 1.60
  • 0.67 (RVUpe) x 0.976 (GPCIpe) = 0.65
  • 0.15 (RVUmp) x 0.889 (GPCImp) = 0.13

Total = 2.38 x CF of $34.8931 = $83.0455

Medicare Allowable Fee = $83.05

So, the Medicare Allowable Fee for code 99203 for a physician in St. Louis is $83.05

1. Question #1: How much is the Medicare Allowable Fee for an office visit for an established patient with a detailed history, a detailed exam and medical decision making of moderate complexity (99214) for a physician in Dallas?

Billing 99214 in Dallas:

• • 1.92 x 1.023 =
  • 0.82 x 1.026 =
  • 0.14 x 0.546 =

1. Question #2: In which city would a physician receive the highest reimbursement for a complete TURP? Use a conversion factor of $34.8931.

TURP (52601)

1. St. Louis:
   • • 13.16 x 1.000 =
     • 6.56 x 0.976 =
     • 1.51 x 0.889 =
   • • 13.16 x 1.023 =
     • 6.56 x 1.026 =
     • 1.51 x 0.546 =
   • • 13.16 x 1.036 =
     • 6.56 x 1.194 =
     • 1.51 x 0.776 =
   • • 13.16 x 1.022 =
     • 6.56 x 1.083 =
     • 1.51 x 1.199 =
2. Question #3: In which city would a physician receive the lowest reimbursement for a colonoscopy with biopsy? Use a conversion factor of $34.8931.

Colonoscopy with biopsy (45380)

1. St. Louis:
   • • 3.56 x 1.000 =
     • 1.87 x 0.976 =
     • 0.42 x 0.889 =
   • • 3.56 x 1.023 =
     • 1.87 x 1.026 =
     • 0.42 x 0.546 =
   • • 3.56 x 1.036 =
     • 1.87 x 1.194 =
     • 0.42 x 0.776 =
   • • 3.56 x 1.022 =
     • 1.87 x 1.083 =
     • 0.42 x 1.199 =
2. Question #4: Calculate the expected payment for an incision and drainage of a pilonidal cyst in each of the cities listed. Use a conversion factor of $34.8931.

Incision and Drainage (10080)

St. Louis:

• • 1.22 x 1.000 =
  • 1.65 x 0.976 =
  • 0.19 x 0.889 =

Total = x CF of $34.8931

St. Louis Medicare Allowable Fee =

Dallas:

• • 1.22 x 1.023 =
  • 1.65 x 1.026 =
  • 0.19 x 0.546 =

Total = x CF of $34.8931

Dallas Medicare Allowable Fee =

Seattle:

• • 1.22 x 1.036 =
  • 1.65 x 1.194 =
  • 0.19 x 0.776 =

Total = x CF of $34.8931

Seattle Medicare Allowable Fee =

Philadelphia:

• • 1.22 x 1.022 =
  • 1.65 x 1.083 =
  • 0.19 x 1.199 =

Total = x CF of $34.8931

Philadelphia Medicare Allowable Fee =