CPT 99214 carries a higher work RVU, higher practice expense RVU, higher malpractice RVU, and a higher national Medicare payment estimate than CPT 99213 in the CY2026 Medicare Physician Fee Schedule (MPFS). The gap is real and it matters for productivity modeling and compensation review, but the RVU spread is a payment and productivity input, not a rule for choosing between the two E/M levels.
What the CY2026 RVU Data Shows
CPT 99213 and 99214 are both established patient office or outpatient evaluation and management (E/M) visits. 99213 corresponds to a lower level of medical decision making (or a shorter typical duration), and 99214 corresponds to a moderate level of medical decision making (or a longer typical duration). The CPT descriptor itself, not the RVU value, is what defines the clinical distinction between the two codes.
For CY2026, CMS finalized a -2.5% “efficiency adjustment” to work RVUs for most non-time-based services, but it explicitly exempted E/M visit codes from that cut. That’s a relevant detail for anyone comparing 2025 and 2026 data: 99213 and 99214 work RVUs did not drop under the efficiency adjustment, unlike many procedural CPT codes.
Based on the CY2026 MPFS data currently used in RVUinUSA’s RVU database:
| Component | 99213 | 99214 | Difference |
|---|---|---|---|
| Work RVU | 1.30 | 1.92 | +0.62 |
| Non-facility PE RVU | 1.46 | 2.00 | +0.54 |
| Facility PE RVU | 0.33 | 0.47 | +0.14 |
| Malpractice (MP) RVU | 0.09 | 0.14 | +0.05 |
These four figures are why any 99213-vs-99214 comparison has to specify which RVU it’s talking about. Work RVU measures the physician’s time, skill, and mental effort. Practice expense (PE) RVU covers overhead — clinical staff time, supplies, equipment, and facility costs — and it comes in two separate values because CMS assumes a physician’s office absorbs more overhead than a hospital-owned facility. Malpractice RVU reflects the relative cost of professional liability insurance for that service. None of these three components is optional; Medicare payment and most RVU-based compensation formulas are built from a mix of them.
Total RVU: Keep the Setting Consistent
Total RVU is the sum used for Medicare payment modeling. Physician productivity compensation usually uses work RVU separately:
Total RVU = Work RVU + Selected PE RVU (facility or non-facility) + MP RVU
Because PE RVU splits into a facility and non-facility value, the total RVU for the same CPT code is different depending on where the service is performed. Work RVU and MP RVU stay identical across both settings — only the PE RVU component changes.
| Setting | 99213 total RVU | 99214 total RVU | Total RVU spread |
|---|---|---|---|
| Non-facility (physician office) | 2.85 | 4.06 | 1.21 |
| Facility (hospital-owned, outpatient) | 1.72 | 2.53 | 0.81 |
Comparing a non-facility 99213 against a facility 99214 (or vice versa) mixes two different cost structures and produces a distorted spread. The setting has to match on both sides of the comparison before the numbers mean anything.
From Total RVU to a Medicare Payment Estimate
Total RVU is not a dollar amount. It becomes a payment figure only after two more inputs are applied: the Geographic Practice Cost Index (GPCI) and the Conversion Factor (CF). The general formula CMS uses per component is:
Payment = [(Work RVU × Work GPCI) + (PE RVU × PE GPCI) + (MP RVU × MP GPCI)] × Conversion Factor
GPCI adjusts each RVU component separately for local labor costs, rent, and malpractice premiums — a locality with high overhead has a PE GPCI above 1.00, while a lower-cost area has a PE GPCI below 1.00. A “national” estimate, the kind commonly quoted in reference tables, assumes a GPCI value of 1.00 for all three components. That’s a simplification: no actual Medicare locality has a GPCI of exactly 1.00 across work, PE, and MP simultaneously, so a national figure is a benchmark, not the payment a specific practice will actually see on a remittance advice.
A second CY2026-specific change matters here: for the first time, Medicare uses two separate conversion factors — one for clinicians who qualify as participants in an Advanced Alternative Payment Model (APM), and one for everyone else. The finalized CY2026 rates are:
| Conversion factor | CY2026 rate | Change from CY2025 |
|---|---|---|
| Qualifying APM (QP) | $33.5675 | +3.77% |
| Non-qualifying APM (non-QP) | $33.4009 | +3.26% |
Most office-based physicians bill under the non-QP conversion factor. Using $33.4009 and national GPCI assumptions:
| Setting | 99213 total RVU | 99213 est. payment | 99214 total RVU | 99214 est. payment | Payment spread |
|---|---|---|---|---|---|
| Non-facility | 2.85 | ~$95.19 | 4.06 | ~$135.61 | ~$40.42 |
| Facility | 1.72 | ~$57.45 | 2.53 | ~$84.50 | ~$27.05 |
Example calculation (illustrative, non-facility, national assumptions):
4.06 total RVU × $33.4009 = $135.61
That figure is a national estimate, not a guaranteed claim payment. Actual reimbursement on a specific claim depends on the locality’s GPCI values, the payer’s own fee schedule if it’s not straight Medicare, sequestration or other statutory adjustments, and whether the billing entity is paid under the QP or non-QP conversion factor. To get a locality-specific number for a real contract or budget model, run both codes through the RVU calculator with the same locality and participant status selected for each.
wRVU-Based Compensation Is Not Medicare Payment
This is where the two most commonly confused numbers on RVUinUSA diverge. Medicare payment RVU — the total RVU shown above — is CMS’s mechanism for calculating what Medicare reimburses a practice for a claim. wRVU-based physician compensation uses only the work RVU component, multiplied by a dollar-per-wRVU conversion rate that the employer sets in the compensation plan, unrelated to the Medicare conversion factor.
Estimated wRVU compensation = Work RVU credited × Employer's $/wRVU rate
If a compensation plan pays $50 per wRVU (an illustrative example rate, not a market benchmark or CMS figure), the 0.62 work RVU spread between 99214 and 99213 is worth about $31 per encounter in credited productivity — a number that has nothing to do with the $40.42 non-facility Medicare payment spread calculated above. The two spreads happen to be in the same range here, but they come from entirely different formulas and will diverge more sharply for codes where PE RVU is a larger share of total RVU, such as procedure or imaging codes.
A compensation plan also determines which RVU schedule year it uses (some practices freeze a prior year’s work RVU table rather than updating annually), which modifiers or supervision arrangements are excluded from credit, and whether split/shared visits, telehealth, or certain payer categories count at all. None of that is defined by the CMS payment RVU — it’s defined by the written employment agreement, which is why a compensation review should confirm the plan’s crediting rules before applying any RVU comparison to expected annual pay.
The RVU Spread Doesn’t Decide the E/M Level
None of the numbers above are a coding rule. CPT 99214 having a higher total RVU and a higher estimated payment than 99213 is a financial consequence of correct code selection — not a justification for selecting it. The applicable CPT guidelines, medical decision making elements or time thresholds, payer-specific documentation policy, and any relevant modifiers determine which code fits a given encounter. RVUinUSA’s calculators and reference pages quantify the payment and productivity impact of a code choice that has already been made correctly; they don’t substitute for documentation review or coding compliance judgment.
Running This Comparison With Your Own Assumptions
To reproduce a clean 99213-vs-99214 comparison:
- Pull the current-year work RVU, PE RVU, and MP RVU for each code from the CPT 99213 RVU Guide and CPT 99214 RVU Guide.
- Hold the setting constant — pick non-facility or facility for both codes, not one of each.
- Apply the same GPCI locality and the same QP/non-QP conversion factor status to both codes before comparing payment.
- If the goal is a compensation projection rather than a payment estimate, move to a wRVU-based compensation tool and apply the employer’s actual $/wRVU rate and crediting rules instead of the Medicare conversion factor.
- If the question involves a specific contract’s RVU crediting terms, cross-check the schedule year and exclusions against the Contract Red Flags Guide before finalizing any projection.
The most common error in this type of comparison isn’t a bad calculator input — it’s mixing settings (comparing office 99213 against facility 99214), mixing years (comparing a 2024 wRVU table against 2026 payment rates), or treating a national payment estimate as an actual locality-specific reimbursement figure. Controlling for setting, year, and locality first is what makes the 0.62 work RVU and roughly $40 non-facility payment spread between these two codes a usable number rather than a misleading one.