Physician Fee Schedule / RVU Lookup

Look up Medicare Physician Fee Schedule data and Relative Value Unit (RVU) breakdowns for HCPCS/CPT codes.

Overview

The Medicare Physician Fee Schedule (PFS) determines how much Medicare pays for physician services. Each procedure code is assigned Relative Value Units (RVUs) across three components:

Work RVU — Physician time, skill, and intensity
Practice Expense (PE) RVU — Overhead costs (staff, equipment, supplies), with separate values for facility and non-facility settings
Malpractice (MP) RVU — Professional liability insurance costs

The total RVU is multiplied by the conversion factor (a dollar amount updated annually by CMS) to calculate the Medicare payment amount.

Endpoints

Method	Path	Description
GET	`/v1/pfs/:hcpcs`	Single PFS/RVU lookup
POST	`/v1/pfs/_batch`	Batch lookup (up to 100 codes)

Single Lookup

Look up RVU data for an office visit

Request

Node.js

const response = await fetch(
  "https://api.fhirfly.io/v1/pfs/99213",
  {
    method: "GET",
    headers: {
    "x-api-key": "YOUR_API_KEY",
  }
  }
);

const data = await response.json();
console.log(data);

Response

JSON

{
  "data": {
    "hcpcs_code": "99213",
    "description": "Office or other outpatient visit for the evaluation and management of an established patient",
    "status_code": "A",
    "rvu": {
      "work": 1.3,
      "pe_non_facility": 1.28,
      "pe_facility": 0.52,
      "mp": 0.07,
      "total_non_facility": 2.65,
      "total_facility": 1.89
    },
    "conversion_factor": 32.74,
    "calculated_payment": {
      "non_facility": 86.76,
      "facility": 61.88
    },
    "indicators": {
      "global_days": "XXX",
      "multiple_surgery": "0",
      "bilateral_surgery": "0"
    }
  },
  "meta": {
    "source": {
      "name": "CMS Physician Fee Schedule",
      "quarter": "2026-Q1"
    },
    "legal": {
      "license": "public_domain",
      "attribution_required": false,
      "source_name": "CMS Physician Fee Schedule/RVU Files",
      "citation": "CMS Physician Fee Schedule Relative Value Files. Accessed via FHIRfly."
    }
  }
}

Parameters

Single Lookup

Parameter	Required	Description
`hcpcs`	Yes	HCPCS/CPT code (path parameter, 4-5 alphanumeric characters)

Batch Lookup

Parameter	Required	Description
`codes`	Yes	Array of HCPCS/CPT codes (request body, max 100)

Understanding the Response

RVU Breakdown

Field	Type	Description
`work`	number	Work RVU — physician effort
`pe_non_facility`	number	Practice Expense RVU for non-facility (office) setting
`pe_facility`	number	Practice Expense RVU for facility (hospital) setting
`mp`	number	Malpractice RVU
`total_non_facility`	number	Sum of work + pe_non_facility + mp
`total_facility`	number	Sum of work + pe_facility + mp

Payment Calculation

Field	Type	Description
`conversion_factor`	number	CMS conversion factor (dollars per RVU)
`calculated_payment.non_facility`	number	`total_non_facility * conversion_factor`
`calculated_payment.facility`	number	`total_facility * conversion_factor`

The calculated payment is the national base rate before geographic adjustments (GPCIs). Actual Medicare payments vary by locality.

Indicators

Field	Type	Description
`global_days`	string \| null	Global surgery period (`"000"`, `"010"`, `"090"`, `"XXX"`, `"YYY"`, `"ZZZ"`)
`multiple_surgery`	string \| null	Multiple surgery indicator
`bilateral_surgery`	string \| null	Bilateral surgery indicator (`"0"` = 150%, `"1"` = 150% if modifier 50, `"2"` = bilateral already included)

Status Codes

Code	Meaning
`A`	Active — separately payable code
`B`	Bundled — payment included in another code
`C`	Carrier-priced — no national fee, priced by MAC
`I`	Invalid — not payable under PFS
`N`	Non-covered — not covered by Medicare
`R`	Restricted — special coverage rules apply

Batch Lookup

Look up RVU data for multiple codes in a single request:

Look up RVU data for multiple codes

Request

Node.js

const response = await fetch(
  "https://api.fhirfly.io/v1/pfs/_batch",
  {
    method: "POST",
    headers: {
    "x-api-key": "YOUR_API_KEY",
    "Content-Type": "application/json",
  },
    body: JSON.stringify({
    "codes": [
      "99213",
      "99214"
    ]
  })
  }
);

const data = await response.json();
console.log(data);

Response

JSON

{
  "count": 2,
  "results": [
    {
      "input": "99213",
      "hcpcs_code": "99213",
      "status": "ok",
      "data": {
        "hcpcs_code": "99213",
        "description": "Office or other outpatient visit, established patient",
        "status_code": "A",
        "rvu": {
          "work": 1.3,
          "pe_non_facility": 1.28,
          "pe_facility": 0.52,
          "mp": 0.07,
          "total_non_facility": 2.65,
          "total_facility": 1.89
        },
        "conversion_factor": 32.74,
        "calculated_payment": {
          "non_facility": 86.76,
          "facility": 61.88
        }
      }
    },
    {
      "input": "99214",
      "hcpcs_code": "99214",
      "status": "ok",
      "data": {
        "hcpcs_code": "99214",
        "description": "Office or other outpatient visit, established patient",
        "status_code": "A",
        "rvu": {
          "work": 1.92,
          "pe_non_facility": 1.73,
          "pe_facility": 0.78,
          "mp": 0.1,
          "total_non_facility": 3.75,
          "total_facility": 2.8
        },
        "conversion_factor": 32.74,
        "calculated_payment": {
          "non_facility": 122.78,
          "facility": 91.67
        }
      }
    }
  ],
  "meta": {
    "legal": {
      "license": "public_domain",
      "attribution_required": false,
      "source_name": "CMS Physician Fee Schedule/RVU Files",
      "citation": "CMS Physician Fee Schedule Relative Value Files. Accessed via FHIRfly."
    }
  }
}

Batch requests count as 1 request toward your rate limit.

SDK Usage

Node.js

import { Fhirfly } from "@fhirfly-io/terminology";

const client = new Fhirfly({ apiKey: "your-api-key" });

// Single lookup
const pfs = await client.claims.lookupPfs("99213");
console.log(`Work RVU: ${pfs.data.rvu.work}`);
console.log(`Non-facility payment: $${pfs.data.calculated_payment.non_facility}`);
console.log(`Facility payment: $${pfs.data.calculated_payment.facility}`);

// Batch lookup
const batch = await client.claims.lookupPfsMany(["99213", "99214"]);
for (const result of batch.results) {
  if (result.status === "ok") {
    console.log(`${result.hcpcs_code}: $${result.data.calculated_payment.non_facility}`);
  }
}

Required Scopes

claims.read — Single and batch PFS/RVU lookups

Physician Fee Schedule / RVU Lookup

Overview

Endpoints

Single Lookup

Look up RVU data for an office visit

Parameters

Single Lookup

Batch Lookup

Understanding the Response

RVU Breakdown

Payment Calculation

Indicators

Status Codes

Batch Lookup

Look up RVU data for multiple codes

SDK Usage

Required Scopes

See Also

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