RVU for Diaphragm Fitting - figuring out what to charge

[Guest guest]

Kathy,

Glad you asked the RVU question, because I was just going to post this RVU question on the list.

My partner wanted me to look up what we should charge for diaphragm fitting since we didn't have this listed in the EMR.

My understanding has always been that you take the RVU x the Conversion Factor and get a price -- of course, there are sometimes issues thrown in like local cost of living, etc, but to get a ball park price, this should work.

My RVU book Relative Values for Physicians gives an RVU for Diaphragm Fitting 57170 of 1.0.

Surgical C onversion Factor for our IPA is 120 – 155 -- see below.

Although I just noticed that it says for CPT 10000-69999 -- so maybe this CF wouldn't apply to the CPT 57170.

http://www.ingenix.com/CodingResources/100196/100197/23380/ No financial relationship to Ingenix -- and it's kind of pricey -- $300+

So, in this case, the maximum fee paid would be $155.

Some prices on the internet showed...

57170 Diaphragm Fitting $105.00

57170 Fitting of diaphragm/cap $46.38 - Medicare

Diaphragm Fitting 57170 RVU=0.91 $87.97

57170 RVU = 1.0

How would you set your rate?

Ultimately, it doesn't matter too much -- at least if insurance is paying, you end up getting paid what they pay anyway -- regardless of what you say you should be paid.

Thanks for any feedback.

Locke, MD