Collections and Payor Mix

Billing for Radiology services has multiple components including Practice Expense (peRVU), Malpractice (mRVU) and Physician Work (wRVU). Based on your practice, these charges can be billed together (global billing) or separate. The Practice Expense component reimburses approximately 4 times the Physician Work component, but this varies by insurance carrier.

The payor mix refers to the type of insurance your patients have. Nationally, approximately 32% of patients are covered by government issued insurance plans (Medicare/Medicaid) and 68% of patients have Private Insurance or Self Pay. There is great variation both between and within states as well as variations between facilities. Private insurers reimburse on average twice (2x) what CMS (Medicare and Medicaid) reimburse, but this varies greatly by practice and carrier. The payor mix of where you work will impact reimbursement.

Default Payor Mix is a national average but can be edited by choosing which state you practice in.

Payor Payor % wRVUs $/wRVU Physician Reimbursement Practice Expense and Malpractice Reimbursement
Medicare/Medicaid % 3840 $33.40 $124,224 $496,896
Private/Self Pay/Other % 8160 $66.80 $527,952 $2,111,808
Subtotal 12000 $652,176 $2,608,704
Write Off (uncollected) % -$32,608 -$130,435
TOTAL RVU Reimbursement $619,568 $2,478,269
Blended $/RVU after Write Off

Medicare/Medicaid Reimbursement is based on 2026 conversion factor. Private Insurance Reimbursement based on an average of 200% Medicare/Medicaid rates. Calculator currently does not account for Geographic Practice Cost Index (GCPI).

Click here for a chart of historical conversion factors
Click here for Payor Mix by State [pdf]

Breakdown of Radiology RVU Based CMS Payments
26 years of Declining Reimbursement (CMS CF) and Declining Work Value (wRVU)

References