How to Increase Your RVUs Honestly: Coding, Documentation and Workflow

How to increase RVUs without working longer hours comes down to one idea: get credit for the work you already do. Studies and coding audits regularly find that clinicians under-code more often than they over-code. Here are compliant ways to close that gap, with Medicare data on where RVUs actually come from. Nothing here is advice to bill for work you didn’t do: upcoding is fraud.

1. Code visit levels to the complexity you actually handle

Since 2021, office visit levels (99202–99215) are chosen by medical decision making (MDM) or by total time on the date of the visit, whichever favors you. Many clinicians still pick a lower level out of habit. The difference is large:

Relative value units for common codes

Code and service	Work RVU 2023	Work RVU 2026	Total RVUs (office)	Medicare national rate (office)
99212 Office o/p est sf 10-19 min	0.70	0.70	1.78	$59.45
99213 Office o/p est low 20-29 min	1.30	1.30	2.85	$95.19
99214 Office o/p est mod 30-39 min	1.92	1.92	4.06	$135.61
99215 Office o/p est hi 40-54 min	2.80	2.80	5.76	$192.39
99203 Office o/p new low 30-44 min	1.60	1.60	3.52	$117.57
99204 Office o/p new mod 45-59 min	2.60	2.60	5.31	$177.36
99205 Office o/p new hi 60-74 min	3.50	3.50	7.09	$236.81

A patient with two or more stable chronic illnesses, or one chronic illness with a medication change, usually meets moderate MDM (99214). Documenting your assessment and the data you reviewed, rather than long templated exam text, is what supports the level.

2. Count total time when it’s higher

Time-based coding includes non-face-to-face work on the same day: reviewing records and tests, ordering, documenting, counseling, and coordinating care. On complex days, time often supports a higher level than MDM.

3. Don’t leave add-on and preventive services unbilled

• Annual wellness visits (G0438, G0439) and the prolonged-service add-on codes.
• Advance care planning (99497, 1.50 work RVUs for the first 30 minutes), often discussed but rarely billed.
• The visit complexity add-on G2211, for longitudinal care of a patient’s serious or complex condition (check current Medicare rules on when it can be reported).
• Chronic care management, transitional care management and behavioral health integration codes, where your team does the qualifying work.
• Procedures done during visits, such as joint injections (20610), with the correct modifier on the visit when the visit is significant and separately identifiable.

4. See where your specialty’s RVUs come from

Comparing your own billing mix with your specialty’s helps spot gaps. In family medicine, Medicare work RVUs are concentrated in a few codes:

Where Family Medicine Medicare work RVUs come from (2023)

Code and service	Work RVU each	Times billed	Share of work RVUs
99214 Office o/p est mod 30-39 min	1.92	15,221,319	37.7%
99213 Office o/p est low 20-29 min	1.30	7,987,692	13.4%
G0439 Ppps, subseq visit	1.92	3,997,001	9.9%
99215 Office o/p est hi 40-54 min	2.80	1,032,273	3.7%
99232 Sbsq hosp ip/obs moderate 35	1.59	1,801,566	3.7%
99233 Sbsq hosp ip/obs high 50	2.40	1,040,530	3.2%
99309 Sbsq nf care moderate mdm 30	1.92	1,156,188	2.9%
99223 1st hosp ip/obs high 75	3.50	464,328	2.1%
99308 Sbsq nf care low mdm 15	1.30	1,032,966	1.7%
99490 Chrnc care mgmt staff 1st 20	1.00	1,331,017	1.7%
99204 Office o/p new mod 45-59 min	2.60	406,317	1.4%
99285 Emergency dept visit hi mdm	4.00	251,325	1.3%

Internal medicine:

Where Internal Medicine Medicare work RVUs come from (2023)

Code and service	Work RVU each	Times billed	Share of work RVUs
99214 Office o/p est mod 30-39 min	1.92	13,638,159	22.4%
99233 Sbsq hosp ip/obs high 50	2.40	6,017,499	12.3%
99232 Sbsq hosp ip/obs moderate 35	1.59	8,363,448	11.4%
99213 Office o/p est low 20-29 min	1.30	6,683,303	7.4%
99223 1st hosp ip/obs high 75	3.50	2,376,600	7.1%
G0439 Ppps, subseq visit	1.92	3,829,224	6.3%
99239 Hosp ip/obs dschrg mgmt >30	2.15	2,277,948	4.2%
99215 Office o/p est hi 40-54 min	2.80	1,413,070	3.4%
99309 Sbsq nf care moderate mdm 30	1.92	1,885,788	3.1%
99308 Sbsq nf care low mdm 15	1.30	1,878,012	2.1%

Other specialties are on each specialty page and in work RVUs by specialty.

5. Increase RVUs by fixing the workflow, not just the coding

• Close notes the same day so nothing is forgotten or left uncoded.
• Use team-based care (rooming, pre-visit planning, standing orders) so your time goes to decisions only you can make.
• Review denied and unbilled claims monthly with your billing team.
• Get a coding audit from a certified coder once or twice a year; ask for both under- and over-coding findings.
• Check your schedule template: slots that are too short force rushed, lower-level visits; too few new-patient slots reduce higher-RVU new visits.

6. Increase RVUs by getting credit for all your work

Check that your employer credits you for services billed under your NPI by advanced practice clinicians you supervise (if your contract says so), for procedures in facilities, and for split/shared visits. Ask for a monthly RVU report you can reconcile against your own logs.

How not to increase RVUs

Don’t choose a level the documentation doesn’t support, clone notes, bill services you didn’t perform, or game time. Payers audit outliers, and Medicare publishes each clinician’s billing, as our doctor pages show. Accurate coding protects you in both directions.

Sources

RVUs: CMS PFS Relative Value Files (opens in a new tab). Office visit coding rules: AMA CPT E/M guidelines (opens in a new tab) and CMS (opens in a new tab). Billing data: CMS Medicare Physician & Other Practitioners (2023). This article is general education, not legal or billing advice; follow your organization’s compliance program. Related: what are RVUs.