Ophthalmology and Optometry Coding Alert

Question: What is the difference between facility and nonfacility relative value units (RVUs)?

South Carolina Subscriber

Answer: CMS assigns codes facility and nonfacility RVUs based on where the physician provides the service. You'll see this variation in RVUs called "site-of-service differential."

Nonfacility RVUs are used to calculate payment when the ophthalmologist provides a service in the office or clinic. CMS applies facility RVUs when the ophthalmologist provides a service in a hospital or ambulatory surgery center.

The higher the RVUs, the more money your office can expect for the procedure or service. Nonfacility RVUs usually pay at a higher rate than facility RVUs because nonfacility RVUs include the expenses required to perform the procedure within an office setting.

For example, the ophthalmologist repairs a retinal detachment with photocoagulation (67105, Repair of retinal detachment, one or more sessions; photocoagulation, with or without draining of subretinal fluid). If the physician performs this procedure in the office, the RVUs are 16.47, but RVUs for the same procedure performed at a hospital are 14.69. These are the national average without figuring in the geographical cost.