Question 1

What is a CPT code?

Accepted Answer

CPT (Current Procedural Terminology) codes are five-digit numeric codes used to describe medical, surgical, and diagnostic services. They are maintained by the American Medical Association and used by healthcare providers, insurers, and Medicare for billing and reimbursement.

Question 2

What is the difference between facility and non-facility rates?

Accepted Answer

Non-facility (office) rates are what Medicare pays when a service is performed in a physician's office. Facility rates are lower because when a service is performed in a hospital or ambulatory surgery center, the facility bills separately for overhead costs like equipment and supplies.

Question 3

What are RVUs?

Accepted Answer

RVU stands for Relative Value Unit. Medicare uses RVUs to measure the value of physician services based on three components: physician work, practice expense, and malpractice cost. Total RVUs are multiplied by the conversion factor ($33.40 in 2026) to calculate the Medicare payment amount.

Medicare Underpayment Audit

No ICD-10-CM record for I20.5