CPT 99214 is the moderate-complexity code in the established patient office/outpatient E/M family (99212–99215), and its 2026 Medicare valuation carries a work RVU of 1.92, unchanged from 2025 because time-based E/M codes were exempted from CMS’s new efficiency adjustment for 2026. What changed materially for 2026 is the facility practice expense (PE) RVU, which CMS reduced as part of a broader policy shift in indirect PE allocation between office and facility settings.
Why 99214’s RVU Profile Changed for 2026
CMS finalized a policy in the CY 2026 Medicare Physician Fee Schedule (MPFS) that reduces the indirect PE allocated to facility-based services relative to non-facility (office) services, on the reasoning that fewer physicians now maintain separate office overhead while working primarily in hospital-owned settings. For CPT 99214, this dropped the facility PE RVU from roughly 0.83 in 2025 to about 0.47 in 2026 — a reduction of more than 40% — while the physician work RVU stayed flat. Non-facility PE RVU for 99214 moved in the opposite direction, since the same policy shifts indirect cost recognition toward office-based practices.
This matters for anyone running Medicare payment or productivity models: a code’s total RVU can shift year to year even when work RVU doesn’t move, purely because of practice-expense methodology changes. Anyone comparing 2025 and 2026 estimates for the same CPT code should pull both years’ RVU files rather than assuming continuity.
99214 RVU Components (2026)
| Component | What it represents | 2026 value* |
|---|---|---|
| Work RVU | Physician time, skill, and mental effort for a moderate-level established patient visit | 1.92 |
| Non-facility PE RVU | Overhead when the visit occurs in the physician’s own office | ≈2.00 |
| Facility PE RVU | Overhead when the visit occurs in a hospital outpatient department or similar facility | ≈0.47 |
| Malpractice (MP) RVU | Professional liability insurance cost allocated to the service | ≈0.13–0.14 |
*These figures reflect CY 2026 CMS Physician Fee Schedule data as published in the final rule and related specialty-society summaries. Malpractice RVU figures for individual codes can be refined between the proposed and final rule stages, so before finalizing a payment estimate, confirm the exact current value in the CMS PFS Look-Up Tool or through RVUinUSA’s RVU calculator, which pulls from the imported CMS data set.
Work RVU is the component most people mean when they say “wRVU” — it’s what shows up in physician compensation formulas. It is not the number CMS uses to set the actual Medicare payment; that requires all three RVU components plus geographic adjustment and a conversion factor.
From RVU to Medicare Payment
Medicare doesn’t pay a flat dollar amount per RVU. Payment is derived through this sequence:
- Each RVU component (work, PE, malpractice) is multiplied by its corresponding Geographic Practice Cost Index (GPCI) for the physician’s locality.
- The geographically adjusted components are summed into the geographically adjusted total RVU.
- The geographically adjusted total RVU is multiplied by the conversion factor (CF) — a dollar figure CMS sets annually.
Medicare payment estimate =
[(Work RVU x Work GPCI)
+ (Selected PE RVU x PE GPCI)
+ (MP RVU x MP GPCI)]
x Conversion FactorFor 2026, CMS introduced a structural change that anyone doing payment modeling needs to know about: there are now two separate statutory conversion factors instead of one:
- $33.57 for clinicians participating in a qualifying Advanced Alternative Payment Model (Advanced APM QP)
- $33.40 for all other physicians and practitioners (non-QP)
Both are increases from the 2025 conversion factor of USD 32.35, driven by a statutory 2.5% update plus separate QP/non-QP adjustments. Most physicians who are not in a qualifying APM arrangement will be paid using the USD 33.40 rate.
National Payment Estimate for 99214
Using national (GPCI = 1.0) assumptions and the non-QP conversion factor:
| Setting | Total RVU | Formula | Estimated national payment |
|---|---|---|---|
| Non-facility (office) | ≈4.06 | 4.06 × $33.40 | ≈$135.61 |
| Facility (hospital outpatient, etc.) | ≈2.53 | 2.53 × $33.40 | ≈$84.50 |
The gap between settings — roughly $51 for the same CPT code — comes almost entirely from the practice expense difference, since physician work RVU and malpractice RVU stay identical across settings. This is a common point of confusion: the CPT code doesn’t determine facility vs. non-facility payment, the place of service does.
These are national estimates before locality GPCI adjustment. Actual payment in a given ZIP code can run higher or lower depending on local wage, rent, and malpractice cost indices — run the code through RVUinUSA’s GPCI calculator with your actual locality before using a number for contract or budget purposes. Also confirm whether the physician or practice is billing under the QP or non-QP conversion factor, since that alone creates a roughly 0.5% difference in payment for identical RVUs.
99214 Compared to 99213 and 99215
99214 sits in the middle of the established patient E/M ladder. The RVU spread between adjacent codes is what practice managers and compensation analysts use to model the financial effect of shifting code mix — not as a justification for choosing a higher-paying code.
| CPT | Descriptor | Work RVU | Approx. total RVU (non-facility, national) | Non-QP estimate at $33.40 CF |
|---|---|---|---|---|
| 99213 | Established patient, low-moderate complexity | 1.30 | ≈2.85 | ≈$95.19 |
| 99214 | Established patient, moderate complexity | 1.92 | ≈4.06 | ≈$135.61 |
| 99215 | Established patient, moderate-high complexity | 2.80 | ≈5.76 | ≈$192.39 |
The work RVU jump from 99213 to 99214 is 0.62; from 99214 to 99215 it’s 0.88. On a high-volume outpatient schedule, that 0.62 wRVU difference compounds quickly — 20 encounters a week shifted from 99213 to 99214 adds roughly 12.4 wRVU weekly, which flows directly into productivity-based compensation models. None of this changes what actually determines whether a visit qualifies as 99213, 99214, or 99215: documentation, medical decision-making complexity or time thresholds under current E/M guidelines, and payer-specific policy. For a focused breakdown of where the boundary between 99213 and 99214 actually falls clinically and administratively, see RVUinUSA’s 99213 vs. 99214 comparison.
wRVU Compensation Is Not Medicare Reimbursement
This is the point where RVU-based analysis most often goes wrong, and it’s worth being explicit about it: Medicare payment and physician compensation are two different calculations that happen to share an input.
Medicare’s payment formula uses total RVU (work + PE + malpractice), locality GPCI, and the CMS conversion factor. A physician’s wRVU-based compensation plan, by contrast, typically uses only the work RVU component, multiplied by a dollar-per-wRVU rate that’s negotiated in the employment contract — a rate that has no fixed relationship to the Medicare conversion factor.
Illustrative example only — not an official rate: if an employment agreement pays $50 per wRVU and credits 99214 in full:
1.92 wRVU x USD 50/wRVU = USD 96.00 credited compensation per encounterCompare that to the ≈$135.61 national non-facility Medicare payment estimate for the same code. The two numbers aren’t meant to match — one reflects what Medicare pays the practice for the total resources involved in the service, the other reflects what an individual employed physician is credited under a specific contract for their work component alone. A few things determine whether the compensation-side number is even meaningful:
- Whether the employment agreement actually credits 99214 as billed (some plans exclude certain visit types or apply caps)
- Whether the contract locks wRVU values to a specific CMS schedule year, which matters given how much facility PE RVUs moved for 2026
- Whether there’s a productivity threshold before the per-wRVU rate applies
- Whether modifiers, shared-visit rules, or split/shared billing affect who gets credited
Before using a wRVU figure for compensation projections, run it through RVUinUSA’s salary calculator and cross-check contract terms with the contract red flags guide — particularly the RVU-schedule-year clause, since a contract that never updates to the current CMS RVU file can quietly under- or over-credit physicians as CMS revalues codes like 99214 annually.
Using 99214 RVU Data in Practice
For a Medicare payment estimate specific to your situation, four inputs have to be locked down together: CPT code, place of service (facility or non-facility), locality, and CMS data year. Changing any one of them changes the output, and mixing years or settings between two numbers you’re comparing produces a meaningless result.
For a compensation or productivity estimate, the inputs are different: credited work RVU, the contracted dollar-per-wRVU rate, any threshold or floor, and the RVU schedule year the contract references. These two workflows should never be run together in the same spreadsheet cell — Medicare’s total-RVU-based payment logic and a physician contract’s work-RVU-based compensation logic answer different financial questions, even when they both start from the same CPT 99214 RVU data.
The practical sequence is to pull 99214’s current-year RVU components, run the payment estimate through the RVU calculator with the correct place of service and locality, and only then move to compensation modeling once the credited wRVU rules from the contract are confirmed separately.