> ## Documentation Index
> Fetch the complete documentation index at: https://docs.rcintell.com/llms.txt
> Use this file to discover all available pages before exploring further.

# 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

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

## Response

```json theme={null}
{
  "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** |

<Note>
  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.
</Note>

## 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**.

<Warning>
  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.
</Warning>

## 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          |