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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.

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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

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Request

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Response

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

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

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Payment breakdown: 27447 (total knee arthroplasty)

A major surgical procedure at the same Kansas facility:
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.

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Facility vs. non-facility rates

Every CPT code has two PE RVU values. The care setting determines which one applies: The non-facility rate is always higher because the physician’s office bears overhead costs (rent, staff, equipment) that hospitals absorb in facility settings.

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Status indicators

The status_indicator field tells you how Medicare treats the code:

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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.

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Combining L5 and L6

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