Resources · Billing & Reimbursement
Billing & Reimbursement
The basics of how neurology care is reimbursed.
Billing & Coding References
Printable references for neurology billing — click to open each PDF.
Billing OverviewHow hospitals and physicians are paid — DRGs, RVUs, and the basics of reimbursement.Open PDF →
CPT Codes & RVUsThe CPT codes every neurologist should know and their physician work RVUs.Open PDF →
RVU & Physician Fee ScheduleHow the RVU converts to payment under the CMS Physician Fee Schedule.Open PDF →How physicians are paid
Physician reimbursement runs on RVUs (Relative Value Units). Here is the whole picture in five steps — from what an RVU is to how the hospital actually pays you.
Step 1 — What does an RVU mean?
An RVU is the “currency” CMS uses to value a service. Each RVU is composed of three parts: the work RVU (wRVU) — the physician-effort component — plus a practice-expense RVU and a malpractice RVU.
→ Full guide: RVU & Physician Fee Schedule (wRVU vs RVU, the conversion factor, and worked examples).
Step 2 — How many wRVU are allocated per encounter?
The work RVUs and CPT codes for the encounters and tests a neurologist bills most often. (wRVU shown is the physician-work component only; values are revised annually by CMS — verify against the current fee schedule.)
Office & inpatient visits
| Service | wRVU | CPT |
|---|---|---|
| Office — New Visit (referred, no consult request) | ||
| Level III | 1.42 | 99203 |
| Level IV | 2.43 | 99204 |
| Level V | 3.17 | 99205 |
| Office — Return Visit | ||
| Level III | 0.97 | 99213 |
| Level IV | 1.50 | 99214 |
| Level V | 2.11 | 99215 |
| Office — New Consult (requires a consult request) | ||
| Level III | 1.88 | 99243 |
| Level IV | 3.02 | 99244 |
| Level V | 3.77 | 99245 |
| Inpatient — New Admission | ||
| Level I | 1.92 | 99221 |
| Level II | 2.61 | 99222 |
| Level III | 3.86 | 99223 |
| Inpatient — Established (subsequent) | ||
| Level I | 0.76 | 99231 |
| Level II | 1.39 | 99232 |
| Level III | 2.00 | 99233 |
| Inpatient — Consult | ||
| Level III | 2.24 | 99253 |
| Level IV | 3.29 | 99254 |
| Level V | 4.00 | 99255 |
| Critical Care | ||
| First hour | 4.50 | 99291 |
| Each additional 30 minutes | 2.25 | 99292 |
| Transitional Care Management | ||
| Moderate complexity | 2.10 | 99495 |
| High complexity | 3.05 | 99496 |
| Prolonged non–face-to-face service | 2.10 | 99358 |
| — each additional | 1.00 | 99359 |
Tests & procedures
| Test / Procedure | wRVU | CPT |
|---|---|---|
| Epley maneuver | 0.75 | 95992 |
| Dix–Hallpike | 0.48 | 92542 |
| Nerve stimulator (VNS/DBS) — interrogation / analysis | 0.45 | 95970 |
| Nerve stimulator (VNS/DBS) — programming | 3.00 | 95974 |
| EEG, routine 20–40 min, awake & drowsy | 1.08 | 95816 |
| EEG, routine 20–40 min, awake & asleep | 1.08 | 95819 |
| EEG, routine 20–40 min, sleep / coma | 1.08 | 95822 |
| EEG, routine 40–60 min | 1.08 | 95812 |
| EEG, routine > 60 min | 1.73 | 95813 |
| Long-term video EEG monitoring (per 24 h) | 5.99 | 95951 |
| Long-term EEG without video (per 24 h) | 3.61 | 95956 |
| Visual evoked potential (VEP) | 0.35 | 95930 |
| Blink reflex study | 0.59 | 95933 |
| SSEP | 0.86 | 95938 |
| BAEP / BSAEP | 0.50 | 92585 |
| Lumbar puncture | 1.37 | 62270 |
Step 3 — How much do we get paid for each wRVU?
The dollars-per-RVU figure is the Medicare conversion factor, which CMS sets each year. For 2026, and as required by statute, there are two factors: $33.40 per RVU for most physicians (non–qualifying-APM) and $33.57 per RVU for qualifying alternative-payment-model participants — up from $32.35 in 2025 (and $35.99 back in 2018).
Step 4 — Some examples
A quick way to read the E&M codes: they all start with 992 and end with the level of care. The 4th digit tells you the setting:
- 0 — new office visit (9920x)
- 1 — follow-up office visit (9921x)
- 2 — initial inpatient encounter (9922x)
- 3 — subsequent inpatient encounter (9923x)
Consultation codes (9924x and 9925x) are used only in limited scenarios — a one-time requested opinion, not ongoing follow-up.
Step 5 — How do hospitals pay physicians?
Physicians are compensated in one of three ways:
- RVU-based: a fixed amount per wRVU generated (commonly ~$50–60 per wRVU). The hospital keeps the practice-expense RVU and the revenue from diagnostics and procedures.
- Shift-based: used for hospitalists and ED physicians — roughly $150–200 per hour.
- Fixed salary: e.g. J-1 waiver physicians, whose salary must be guaranteed for the 3-year waiver duration. (Locum tenens — Latin for “place holder” — is the temporary-coverage equivalent.)
→ How hospitals themselves are paid by Medicare (IPPS & DRGs)
Ahmed Koriesh, MD
RVU & Physician Fee ScheduleHow the RVU converts to payment under the CMS Physician Fee Schedule.Open →Billing for HospitalsHow hospitals are paid by Medicare — IPPS, DRGs, and the CC/MCC tiers.Open →
HCC Coding & Risk AdjustmentRisk adjustment, HCCs, the RAF score, and the coding/compliance rules that decide whether your codes hold up.Open →