Office vs. facility
Where the service happens. In your own clinic (office), Medicare also pays you for the room, staff and supplies — so it's higher. In a hospital or ASC, the facility bills that part separately.
wRVU
Work Relative Value Units — the physician-effort share of a code. Most employment contracts pay a set dollar amount per wRVU, independent of Medicare's rate.
Add-on codes
Billed only alongside a primary. 64491 is each extra unit — the stepper adds them to the whole-procedure total.
Conversion factor
The dollars-per-RVU Medicare multiplies by. Set once, it flows through every figure on this page. The QP rate applies to clinicians who qualify as Advanced APM participants — a small annual boost.
GPCI
Geographic Practice Cost Index — adjusts the work, practice-expense and malpractice RVUs for your locality's cost of living before they're multiplied by the conversion factor.
How payment is computed
Each RVU is scaled by your locality's GPCI, summed, then multiplied by the conversion factor:
(work·wGPCI
+ PE·peGPCI
+ MP·mpGPCI) × CF
This code's Global fee
(1.77·1.000
+ 4.20·1.000
+ 0.17·1.000) × $33.40 = $205.08