How the CBHPM Table calculates physician fees

The CBHPM table defines the physician fee from two components: the value of the procedure’s tier and, when applicable, the operational cost calculated by the UCO (Operational Cost Unit). Understanding this formula precisely prevents the hospital or the physician from billing an incorrect amount, whether too little, losing revenue, or too much, causing a denial.

This article explains the formula for calculating the physician fee under the CBHPM, with a practical example using the UCO value in force.

The components of the calculation: tier and UCO

The CBHPM does not show monetary values directly in the list of procedures. Instead, each procedure is assigned a tier, represented by a number and a letter, such as 5C, which corresponds to a reference value in a separate tier table published by the AMB (Brazilian Medical Association). When the procedure also has an operational cost, that cost is calculated by multiplying the procedure’s number of UCOs by the current UCO value.

The full calculation formula

The CBHPM physician fee follows the formula: (tier value multiplied by the tier fraction, when there is one) plus (the procedure’s number of UCOs multiplied by the current UCO value) equals the fee amount. When the procedure has no operational cost in the table, only the tier value makes up the fee.

The UCO value currently in force

The UCO reference value was adjusted by the AMB in October 2025, based on the INPC/IBGE inflation index (5.10%), setting the new value at R$ 29.80, in force from October 2025 to September 2026. This value must be used in any operational cost calculation until the next adjustment. Looking up the CBHPM and AMB tables helps you understand the full context of these adjustments.

A practical calculation example

Consider a surgical procedure classified as tier 5C, with an operational cost of 10 UCOs in the table. The tier value used in this example is illustrative, since the table of values by sub-tier is proprietary to the AMB and must be consulted directly at the official source for the exact current value.

Operational cost calculation: 10 UCOs × R$ 29.80 (current value) = R$ 298.00.

Total fee calculation: the value of tier 5C, taken from the official table, plus R$ 298.00 in operational cost.

The same procedure may have its operational cost calculated with a UCO value different from the AMB standard, if the payer has negotiated its own value in the contract. In that case, the reference value changes, but the calculation formula stays the same.

Why you should always consult the current official table

Tier and UCO values change with AMB adjustments, published through normative resolutions of the CNHM (National Medical Fees Commission) and official notices, without necessarily a new edition of the CBHPM. Using an outdated table is one of the most common causes of discrepancy between the amount billed and the amount the payer expects. Looking at how the CBHPM code is structured helps confirm the correct tier for each procedure before applying the calculation.

A correct calculation starts with the right table, not just the right formula

Knowing the formula for calculating the physician fee under the CBHPM is only part of the process. The final amount depends on using the correct edition of the table, the current tier value and the updated UCO value, both the AMB standard and the one negotiated with each payer.

Rivio is an artificial intelligence platform that automatically applies the current tier and UCO value to each procedure billed, reducing the risk of incorrect calculations caused by outdated tables.

Frequently asked questions about calculating the CBHPM physician fee

What is the formula for calculating the physician fee under the CBHPM?

(Tier value multiplied by the tier fraction, when there is one) plus (the procedure’s number of UCOs multiplied by the current UCO value). When there is no operational cost, the fee is just the tier value.

What is the UCO value currently in force?

R$ 29.80, adjusted by the AMB in October 2025 based on the INPC/IBGE index, in force until September 2026.

Where can you find the tier value for each procedure?

In the official CBHPM table, published by the AMB, which associates each procedure code with a tier and, when applicable, a number of UCOs.

Is the UCO value the same for all payers?

Not necessarily. The standard value is set by the AMB, but payers can negotiate their own UCO value in the contract, which changes the result of the calculation without changing the formula.

Why does using an outdated table cause billing problems?

Because tier and UCO values are adjusted periodically. Using old values results in a charge that differs from what the payer expects to pay, a common cause of denials for table discrepancy.