What is an RVU? How work RVUs set physician pay

An RVU, or relative value unit, is the number Medicare assigns to a medical service to measure its relative cost: physician work, practice expense, and malpractice. Multiplied by a conversion factor, it sets the payment. Numetix tracks wRVU productivity for medical practices so physician pay matches collections.

Numetix is the expert-led, AI-powered, human-in-the-loop bookkeeping layer that connects wRVU productivity to actual collections, so a practice owner can see whether physician pay per wRVU is still affordable. This guide explains how RVUs work, what a 2026 visit pays, and the two ratios worth reviewing every month.

What is an RVU in healthcare?

Medicare sets physician payment through the resource-based relative value scale. Each billable service receives relative value units that add three components: physician work, practice expense, and malpractice insurance. Work reflects the time, skill, effort, and risk of the physician's own part of the service. Practice expense covers resources such as office rent and staff wages. Malpractice reflects the cost of professional liability coverage, as described in this AAFP explanation of RVUs.

Because RVUs are relative, an RVU is not a dollar amount. A service with 4.06 RVUs is worth about twice a service with 2.03 RVUs, and a conversion factor turns that ratio into a payment. Medicare and other payers have used the same relative values for decades, which is why physician compensation plans so often refer to them. A published fee schedule is the dollar version of those relative values.

How many RVUs is a 99214 worth?

CMS publishes the values in a yearly relative value file. The table below uses the 2026 file (RVU26B, updated May 1, 2026) for the three most common established-patient office visit codes. National payment multiplies total non-facility RVUs by $33.4009, the 2026 conversion factor for clinicians who are not qualifying alternative payment model participants.

In a facility setting the 99214 total is 2.53 RVUs instead of 4.06, because the facility bills separately for its own overhead. A practice that performs most visits in a hospital outpatient department should therefore model the facility column, not the office column.

CMS also applied a 2.5 percent efficiency adjustment in 2026 to the work RVUs of non-time-based services such as procedures, radiology, and diagnostic tests. The rule exempts time-based codes, including evaluation and management visits, so the 99214 work value of 1.92 was not reduced. The adjustment is described in the CMS fact sheet for the 2026 final rule.

How much does one RVU pay?

Payment equals three products added together: each RVU component multiplied by its own geographic practice cost index, then the sum multiplied by the conversion factor. For 2026 CMS finalized two conversion factors for the first time: $33.57 for clinicians who qualify as advanced alternative payment model participants and $33.40 for everyone else, compared with $32.35 in 2025.

The indexes come from the CMS 2026 geographic file, and the payments use the non-qualifying factor of $33.4009. A qualifying participant paid at $33.5675 would see the national 99214 figure rise to $136.28. The same service carries the same RVUs everywhere; only the local cost indexes and the factor change the dollars.

What is the difference between wRVU and total RVU?

A work RVU, or wRVU, counts only the physician work component. Total RVUs add practice expense and malpractice. Medicare pays the practice on total RVUs, but many physician pay plans credit wRVUs, because work RVUs follow what the physician personally performs rather than the overhead of the setting. Confirm which measure the employment contract uses before comparing any two physicians. The common structures are compared in our guide to physician compensation models, and the payroll side is covered in physician compensation and medical practice payroll.

What a practice owner should track beside wRVUs

Consider an illustrative practice that pays a physician $240,000 for 4,800 wRVUs. That is $50.00 per wRVU. If the practice collects $720,000 on the same work, it collects $150.00 per wRVU, and physician pay equals 33.33 percent of collections.

Now suppose the payer mix drifts toward lower-paying plans and collections fall to $135.00 per wRVU, or $648,000. Productivity and pay have not changed, yet physician pay rises to 37.04 percent of collections. A wRVU report alone would show nothing wrong.

Two ratios therefore belong on the monthly close: pay per wRVU and collected dollars per wRVU. Market rates for pay per wRVU vary widely by specialty and region, so judge them against the practice's own contract and collection history instead of a published average. The broader monthly review is outlined in the healthcare accounting guide for practice owners.

Frequently asked questions

How many RVUs is a 99214 worth?

For 2026, CPT 99214 carries 1.92 work RVUs and 4.06 total RVUs in an office setting, according to the CMS relative value file. In a facility setting the total is 2.53, because the facility bills its own overhead. At the 2026 non-qualifying conversion factor, 4.06 RVUs equals about $135.61 before any locality adjustment.

Is an RVU the same as a dollar payment?

No. An RVU is a relative weight. Payment comes from multiplying each RVU component by its geographic index, adding the results, and multiplying by the conversion factor. Under the 2026 files, the same 99214 pays about $125.23 in Alabama and $153.27 in Manhattan, because local costs differ while the RVUs stay the same.

Does the 2026 efficiency adjustment cut office visit RVUs?

Not for time-based codes. CMS applied a 2.5 percent reduction to work RVUs for non-time-based services such as procedures, radiology, and diagnostic tests, and exempted time-based codes, including evaluation and management visits, telehealth list services, and new codes. A procedure-heavy practice should model that reduction separately from its office visit revenue.