Reimbursement Calculations

Blue Cross and Blue Shield of New Mexico (BCBSNM) is pleased to make available the RBRVS relative values units (RVUs) to calculate your reimbursement. Providers were notified in a letter mailed in April 2011 and in the August Blue Review that we were not proceeding with the annual update in July 2011 due to the changes made by the Centers for Medicare & Medicaid (CMS) Services.

The changes included a decision to implement a decrease in the RBRVS conversion factor with a concurrent increase to certain RVUs. However, new codes will continue to be added to the system and the average sale price (ASP) for injectable drugs will be updated quarterly.

As a result, the March 2010 RVUs currently being used are no longer available on the CMS website. To assist our providers, view our current RBRVS RVUs for facility and non-facility , as well as flat fees  for services such as clinical laboratory and durable medical equipment.

To get the fee for the RBRVS-based CPT® code, multiply the unit value by your contract agreement conversion factor which can be found on the reimbursement attachment.

The fees derived are not a guarantee of payment. Services represented are subject to provisions of the health plan including, but not limited to: membership, eligibility, premium payment, claim payment logic, provider contract terms and conditions, applicable medical policy, benefit limitations and exclusions, bundling logic, and licensing scope of practice limitations. Maximum allowable may change from time to time subject to notice requirements of applicable law and regulations and prevailing provider agreement. CPT codes are copyright by American Medical Association.