R590. Insurance, Administration.R590-267. Personal Injury Protection Relative Value Study Rule.
R590-267-1. Authority.
This rule is promulgated by the commissioner pursuant to Section 31A-2-201.
R590-267-2. Purpose and Scope.
(1) The purpose of this rule is to establish a reasonable value of services and accommodations for the diagnosis, care, recovery, or rehabilitation of an injured person under automobile personal injury protection coverage under Subsection 31A-22-307(1)(a).
(2) This rule applies to services and accommodations provided under automobile personal injury protection coverage under Subsection 31A-22-307(1)(a) on or after January 1, 2014.
R590-267-3. Definitions.
Terms used in this rule are defined in Section 31A-1-301. Additional terms are defined as follows:
(1) "Conversion factor" means a multiplier used to convert the relative value unit or units of a service or a procedure to a reimbursement rate.
(2) "Relative value unit" means a numerical value assigned to a medical or dental procedure as published in an edition of the RVP or RVD.
(3) "RVD 2025" means 2025 Edition of the Relative Values for Dentists published by Optum, website: www.optumcoding.com, and incorporated by reference within this rule.
(4) "RVD 2023" means 2023 Edition of the Relative Values for Dentists published by Optum, website: www.optumcoding.com, and incorporated by reference within this rule.
(5) "RVP 2025" means 2025 Edition of the Relative Values for Physicians published by Optum, website: www.optumcoding.com, and incorporated by reference within this rule.
(6) "RVP 2023" means 2023 Edition of the Relative Values for Physicians published by Optum, website: www.optumcoding.com, and incorporated by reference within this rule.
R590-267-4. Conversion Factors.
(1)(a) The following conversion factors shall be used with RVP 2025 to determine the reasonable value of each medical service or accommodation provided on or after January 1, 2026:
(i) anesthesia, 127.29;
(ii) surgery, 266.92;
(iii) radiology, 38.34;
(iv) pathology, 24.67;
(v) medicine, 14.67;
(vi) evaluation and management, 21.41.
(b) The conversion factor used with RVD 2025 to determine the reasonable value of each dental service or accommodation provided on or after January 1, 2026 shall be 86.88.
(2)(a) The following conversion factors shall be used with RVP 2023 to determine the reasonable value of each medical service or accommodation provided from January 1, 2024 through December 31, 2025:
(i) anesthesia, 116.11;
(ii) surgery, 248.75;
(iii) radiology, 37.50;
(iv) pathology, 25.00;
(v) medicine, 13.81; and
(vi) evaluation and management, 16.81.
(b) The conversion factor used with RVD 2023 to determine the reasonable value of each dental service or accommodation provided from January 1, 2024 through December 31, 2025 shall be 75.00.
R590-267-5. Fee Schedule.
The reasonable value of any service or accommodation shall be calculated by multiplying the relative value unit assigned to the service or accommodation by the applicable conversion factor prescribed in Section R590-267-4.
R590-267-6. Severability.
If any provision of this rule, Rule R590-267, or its application to any person or situation is held invalid, such invalidity does not affect any other provision or application of this rule that can be given effect without the invalid provision or application. The remainder of this rule shall be given effect without the invalid provision or application.
KEY: relative value study
Date of Last Change: January 1, 2026
Notice of Continuation: October 13, 2023
Authorizing, and Implemented or Interpreted Law: 31A-2-201(3); 31A-22-307(2)
