How wRVU pay works, and what to check in your contract

Every service in the Medicare Physician Fee Schedule carries three relative value units (RVUs): one for the clinician’s work, one for practice expense and one for malpractice cost. The work RVU, or wRVU, is the part that reflects the clinician: the time a service takes, the technical skill and physical effort, the mental effort and judgment, and the stress of the risk involved.

Medicare uses all three to set a payment. Many employers use only the first to measure productivity and pay for it.

What a wRVU is worth in Medicare’s file

CMS publishes the RVUs for every payable code four times a year. In the October 2026 release (RVU26D):

A clinic day of eight 99213 visits, ten 99214, two 99215 and six G2211 add-ons comes to 37.18 wRVUs. Over 20 clinic days a month, that is 744 wRVUs a month and about 8,900 a year.

How contracts turn wRVUs into pay

Employment contracts that pay for productivity usually take one of three shapes:

• Productivity only. Pay is the year’s wRVUs times a rate per wRVU set in the contract.
• Base plus productivity. A guaranteed salary covers wRVUs up to a threshold, and wRVUs above it earn the rate.
• Base with a reconciliation. A salary is paid during the year and adjusted up or down against wRVUs at year end.

The rate per wRVU is a number the employer and physician agree on. It is separate from Medicare’s conversion factor ($33.4009 in 2026 for most clinicians), which is what Medicare pays the practice per RVU of a service, before the geographic adjustment. The two numbers measure different things, so comparing them says little: the employer pays for the clinician’s work out of revenue from all three RVU components and from every payer, not only Medicare.

Federal rules require that pay to an employed physician be consistent with fair market value and not depend on the volume or value of referrals. A productivity bonus based on services the physician personally performs is allowed under the employment exception to the physician self-referral law (42 CFR 411.357(c)).

What to check in the contract

These terms change what the same work is worth. Ask for each in writing.

1. Which year’s RVUs. Some contracts fix the RVU values of a past year. CMS revalues codes every year, so a fixed year can raise or lower your credit for the same visits. For 2026, CMS cut the work RVUs of services that are not priced by time, such as procedures, imaging and diagnostic tests, by 2.5 percent as an “efficiency adjustment”. Time-based services, including office visits, care management and behavioral health, were exempt.
2. How reductions are credited. When several procedures are done in one session, Medicare reduces the payment for all but the first. Ask whether your wRVU credit is reduced the same way, and how assistant-at-surgery, co-surgeon and bilateral services are counted.
3. Shared and split visits, and supervised work. Ask who is credited when a visit is shared with a nurse practitioner or physician assistant, and whether supervision earns credit.
4. Add-on codes. Codes such as G2211 add wRVUs to many visits. Ask whether the employer’s system counts them.
5. Services without a Medicare value. Some codes are bundled or priced locally and have no wRVUs in the file, or none that Medicare pays. Ask how call, teaching, administrative time and those codes are paid.
6. The threshold and the true-up. For base-plus-productivity contracts, ask how the threshold was set, whether it is prorated for leave, and whether a shortfall is clawed back.
7. The report. Ask for the monthly wRVU report by code, so you can check it against the CMS values.

Check your own numbers

The RVU and wRVU calculator adds up the wRVUs for the codes you bill in a shift, day, week or month and scales them to a year, so you can compare the result with your employer’s report. 2MM+ members can also download it as an Excel worksheet and save it. Our physician pay pages show what each specialty’s federal wage figures equal in wRVUs at a rate you enter.

This article is general information, not legal, tax or financial advice. Have an attorney who represents you review any employment contract.

Sources

1. Centers for Medicare & Medicaid Services. PFS Relative Value Files, RVU26D (October 2026 release), PPRRVU2026_Oct_nonQPP.csv. https://www.cms.gov/medicare/payment/fee-schedules/physician/pfs-relative-value-files
2. Centers for Medicare & Medicaid Services. Physician Fee Schedule. https://www.cms.gov/medicare/payment/fee-schedules/physician
3. Centers for Medicare & Medicaid Services. CY 2026 Physician Fee Schedule final rule (CMS-1832-F), released October 31, 2025: efficiency adjustment to work RVUs.
4. 42 CFR 411.357(c), bona fide employment relationships. https://www.ecfr.gov/current/title-42/section-411.357