L6: Service

Resolve specific RVU values, GPCI-adjusted payment, and facility vs. non-facility rates for a CPT code

Layer 6 is the most granular layer — it resolves the specific RVU values for a CPT code, applies the facility’s GPCI from L1, and calculates the expected Medicare payment. This is where billing context becomes a dollar amount.

How L6 uses prior layers

L6 depends on two upstream layers:

• L1 (Location) provides the GPCI values for geographic adjustment
• L3 (Care Setting) determines whether to use the facility or non-facility PE RVU

L1 → GPCI {pw: 1.000, pe: 0.904, mp: 0.504}
L3 → care_setting = "outpatient" → facility = true
L6 → 99213 RVUs × GPCI × CF = $75.00

Request

curl "https://api-dev.rcintell.com/v1/knowledge/layers/170001/l6?cpt=99213" \
  -H "X-API-Key: $RCI_API_KEY"

Response

{
  "layer": "l6_service",
  "data": {
    "cpt": "99213",
    "description": "Office/outpatient visit, established, low complexity",
    "rvu": {
      "work": 1.30,
      "pe_facility": 0.99,
      "pe_nonfacility": 1.81,
      "mp": 0.10
    },
    "global_period": "XXX",
    "status_indicator": "A",
    "payment": {
      "work_rvu_adjusted": 1.3,
      "pe_rvu_adjusted": 0.895,
      "mp_rvu_adjusted": 0.0504,
      "total_adjusted_rvu": 2.2454,
      "conversion_factor": 33.40,
      "estimated_payment": 75.0,
      "facility_rate": true
    }
  }
}

Payment breakdown: 99213 (E/M office visit, established patient)

A common E/M visit at a Kansas hospital outpatient department:

Component	Base RVU	GPCI (KS)	Adjusted RVU
Work	1.30	× 1.000	1.3000
Practice Expense (facility)	0.99	× 0.904	0.8950
Malpractice	0.10	× 0.504	0.0504
Total			2.2454
× Conversion Factor		× $33.40	$75.00

Payment breakdown: 27447 (total knee arthroplasty)

A major surgical procedure at the same Kansas facility:

Component	Base RVU	GPCI (KS)	Adjusted RVU
Work	20.72	× 1.000	20.7200
Practice Expense (facility)	12.12	× 0.904	10.9565
Malpractice	3.25	× 0.504	1.6380
Total			33.3145
× Conversion Factor		× $33.40	$1,112.70

Total knee arthroplasty (27447) has a 90-day global period, meaning all related follow-up visits for 90 days post-surgery are included in the $1,112.70 physician payment. The facility payment (DRG-based) is separate and significantly larger.

Facility vs. non-facility rates

Every CPT code has two PE RVU values. The care setting determines which one applies:

Code	Description	PE (facility)	PE (non-facility)	Payment difference (KS)
99213	E/M established, low	0.99	1.81	$75.00 vs$102.35
99214	E/M established, moderate	1.37	2.60	$107.62 vs$148.72
99215	E/M established, high	1.80	3.39	$152.76 vs$205.87

The non-facility rate is always higher because the physician’s office bears overhead costs (rent, staff, equipment) that hospitals absorb in facility settings.

Status indicators

The status_indicator field tells you how Medicare treats the code:

Status	Meaning
A	Active — paid under MPFS
B	Bundled — payment included in another service
C	Carrier-priced — no national RVU; MAC sets payment
I	Not valid for Medicare — invalid for billing
N	Non-covered — not a Medicare benefit
R	Restricted — special coverage rules apply
T	Injections — paid under MPFS with special rules

RVU data source

L6 resolves RVU values from the CMS Physician Fee Schedule Relative Value Files, updated annually. The conversion factor for 2026 is $33.40.

If a CPT code is not found in the RVU table, L6 returns a note indicating the code requires the CMS data loader. Make sure your environment has loaded the current year’s MPFS data using the data loader.

Combining L5 and L6

L5 and L6 work together to give you the full service picture:

Question	Answer from
What service group is this?	L5
What are the documentation requirements?	L5
What modifiers are relevant?	L5
What is the global period?	L6
What are the exact RVU values?	L6
What is the expected payment?	L6