I would recommend staying in the same body area, the RVU's are not the same for hip and shoulder and the shoulder are not describing what was actually performed. We could be unnessarily short-changing the physicians work. Here is a policy from a commercial carrier to maybe give some guidance on the thought process. I could not find any specific information from the CMS website.
Codes without an Established Fee[/B]Reimbursement amounts are defined in provider contracts. When a contract states that reimbursement for a HCPCS/CPT code is to be RVU-based and CMS has not published an RVU and the code is not an unlisted code, the following guidelines will be used, in this order, to establish a fee for a HCPCS/CPT code:
RVUs published by Optum in The Essential RBRVS. (For modifier-26 and –TC codes, Ingenix RVUs will be used only when CMS has determined that the code-modifier combination is valid. If CMS has determined a code is invalid with -26 or –TC, no pricing will be established for the combination.)
CMS Local Carrier published fee
When the above allowances are not available, the following comparable service methodology is used.
Base the allowance on the most closely comparable code. In the case of a laparoscopic procedure without a specific CPT or HCPCS code, base the allowance on the most closely comparable open code. Base the allowance on the most closely comparable code with modifier -22.
When the procedure or service is a combination of two or more existing CPT or HCPCS codes or components of these codes, determine the appropriate combination of the applicable CPT or HCPCS code components and base the allowance on those.
Base the allowance on a percentage of charges.
Unlisted Codes
Unlisted codes generally cannot have fees established and will be priced using the methodology described in step 3 above every time they are submitted on a claim. Appropriate medical records such as operative report, may be required to price the claim.