How to verify a figure
Every code page, and every answer our connector gives, names the CMS release its figure came from. Find that release below, then compare the figure with CMS’s own file for it. CMS can retire or replace a file at a web address, so the SHA-256 and not the address identifies the exact file we archived.
payment = (work RVU x work GPCI + practice-expense RVU x practice-expense GPCI + malpractice RVU x malpractice GPCI) x conversion factor, rounded half up to the cent on the exact product. Where the OPPS cap for a locality is lower, the cap is the amount; the professional component (-26) is never capped. The national figure uses every GPCI = 1.000 and no cap.
The RVUs are CMS’s own values for the code, modifier and release, from the files listed for that release. Each locality carries its three GPCIs and any OPPS cap, and the release has one conversion factor. The Medicare rate lookup and the code pages use the same calculation, and each code page shows its RVUs and the conversion factor in its working.