CPT 99202 carries a 0.93 work RVU in the 2026 Medicare Physician Fee Schedule (MPFS), with a non-facility total RVU of 2.25 and a facility total RVU of 1.23. At the national non-QP conversion factor of $33.4009, that converts to an estimated Medicare payment of about $75.15 in the office setting and $41.08 in a facility setting, before any locality (GPCI) adjustment is applied.
Those numbers come from the 2026 CMS National Physician Fee Schedule Relative Value File. Because CMS updates RVUs and the conversion factor annually — and because 2026 introduced separate conversion factors for qualifying APM participants ($33.57) and everyone else ($33.40) — any 99202 dollar figure should always travel with its data year, setting, and conversion-factor type attached.
99202 RVU components (2026)
| Component | Value | What it represents |
|---|---|---|
| Work RVU | 0.93 | Physician time, skill, and effort for a straightforward, 15-minute-reference new patient visit |
| Non-facility PE RVU | 1.25 | Overhead when the physician’s own office bears supply, staff, and equipment costs |
| Facility PE RVU | 0.23 | Reduced overhead when a hospital or facility absorbs most practice-expense costs |
| Malpractice (MP) RVU | 0.07 | Liability insurance cost allocated to this service |
| Total RVU (non-facility) | 2.25 | Work + non-facility PE + MP |
| Total RVU (facility) | 1.23 | Work + facility PE + MP |
The gap between the two total RVU figures is driven entirely by practice expense — work RVU and malpractice RVU don’t change by setting. That’s why the same CPT code, billed for the same visit, pays roughly 45% less when the service is furnished in a facility rather than a physician’s own office: the facility itself is already being paid separately for overhead through its own payment system.
What work RVU actually measures
Work RVU is CMS’s estimate of physician effort — time, mental effort, technical skill, physical effort, and the stress of the procedure’s risk — relative to other services. It is not a payment amount and it is not a dollar figure. A code with a higher work RVU simply reflects more relative physician effort than a code with a lower one; converting that number into a dollar estimate requires the other two RVU components plus GPCI and the conversion factor.
This distinction matters because work RVU appears in two very different contexts that get conflated constantly:
- Medicare payment context: work RVU is one of three inputs (with PE RVU and MP RVU) that produce total RVU, which is then multiplied by GPCI factors and the conversion factor to estimate a Medicare-allowed amount.
- Physician compensation context: many employment contracts pay physicians a flat dollar rate per credited work RVU (a “$/wRVU” model), independent of what Medicare or any specific payer actually reimburses for that visit.
These are related but not interchangeable. A physician’s wRVU-based compensation for a 99202 visit is set by contract terms, not by the Medicare fee schedule, even though both use the same 0.93 work RVU value as a starting point.
How the Medicare payment estimate is built
CMS applies a Geographic Practice Cost Index (GPCI) to each RVU component before the conversion factor is applied, because labor, rent, and liability costs vary by locality. The general structure is:
Total RVU = (Work RVU x Work GPCI) + (PE RVU x PE GPCI) + (MP RVU x MP GPCI)
Estimated Medicare Payment = Total RVU x Conversion Factor
At national GPCI values (all factors set to 1.0), GPCI has no effect, which is why the $75.15 and $41.08 figures above are treated as a national reference point rather than an actual claim amount. To illustrate how locality changes the result, consider an illustrative, non-official example where a locality’s GPCI values happen to average roughly 1.10 across work, PE, and malpractice components for 99202 non-facility:
Illustrative total RVU = 2.25 x 1.10 ≈ 2.48
Illustrative payment = 2.48 x $33.4009 ≈ $82.75
This is an example calculation only — actual GPCI values differ by component and by specific locality, and real MPFS payment also reflects sequestration, MIPS payment adjustments, and any applicable modifiers. For an actual locality-specific figure, GPCI values need to be pulled per component (work, PE, malpractice) and applied separately, which is what a GPCI-aware RVU calculator is built to do rather than a flat multiplier.
99202 versus other new patient E/M levels
99202 sits at the low end of the new patient office/outpatient family (99202–99205), which is organized by medical decision-making complexity or time. Comparing RVU values across this family is useful for understanding the productivity and payment spread — it is not a tool for deciding which level applies to a given encounter, which depends on documentation, medical decision making, or time thresholds under current E/M guidelines.
| CPT | Work RVU | Non-facility total RVU | 2026 non-QP national estimate |
|---|---|---|---|
| 99202 | 0.93 | 2.25 | $75.15 |
| 99203 | 1.60 | 3.52 | $117.57 |
| 99204 | 2.60 | 5.31 | $177.36 |
| 99205 | 3.50 | 7.09 | $236.81 |
Moving from 99202 to 99205 roughly quadruples both work RVU and estimated national payment, which is a useful sanity check when auditing whether a practice’s new-patient coding distribution looks unusually concentrated at one level. For a deeper breakdown of the two adjacent codes, see the CPT 99203 RVU guide and the CPT 99205 RVU guide.
Don’t compare 99202 against established-patient codes directly
99202 is frequently searched alongside 99212 and 99213 because all three sit at the lower end of office E/M coding, but they answer different clinical and administrative questions: 99202 applies only to new patients, while 99212 and 99213 apply to established patients. New-patient codes generally carry higher RVU values than their established-patient counterparts at a similar complexity level, because a new patient encounter typically requires more physician work to establish history, review records, and set a care plan.
| CPT | Patient type | Work RVU | Non-facility total RVU (2026) |
|---|---|---|---|
| 99202 | New patient | 0.93 | 2.25 |
| 99212 | Established patient | 0.70 | 1.78 |
| 99213 | Established patient | 1.30 | 2.85 |
Note that 99213 actually carries a higher work RVU and total RVU than 99202, despite being an established-patient code — a reminder that “new vs. established” and “higher vs. lower RVU” are two separate axes, not a single ranking. RVU comparisons across these families explain payment economics after the code family and level are already supported by documentation; they don’t function as a coding decision tool.
Using 99202 in compensation and productivity models
When an employment contract includes wRVU-based compensation, 99202 contributes its 0.93 work RVU to a physician’s production total only if the contract’s credited-service list includes new patient office visits and doesn’t exclude low-complexity levels. From there, annual compensation impact depends on a chain of contract-specific variables:
- New patient visit volume and how new-patient access is scheduled or gatekept
- The contract’s dollars-per-wRVU conversion rate
- Any productivity threshold before incentive compensation begins
- Whether modifiers, split/shared visits, or incident-to billing change wRVU crediting
- Whether the contract locks wRVU values to a specific CMS schedule year or updates them annually
A simplified compensation illustration (not a Medicare payment calculation) might look like this:
Annual 99202 wRVU credit = 0.93 wRVU x annual 99202 visit count
Estimated compensation contribution = Annual 99202 wRVU credit x contracted $/wRVU rate
If a contract credits $45 per wRVU and a physician bills 300 99202 visits in a year, that’s 0.93 × 300 = 279 wRVUs, or roughly $12,555 in compensation attributable to that code — a figure entirely separate from what Medicare or any commercial payer actually reimbursed for those same 300 visits. Reviewing this distinction carefully is one of the more common blind spots physicians run into when evaluating offer letters; the contract red flags guide walks through the clauses that most often obscure it.
Working with the RVU calculator
To turn these reference values into a locality-specific number, the practical sequence is: confirm the current-year RVU components on the CPT 99202 page, select facility or non-facility setting, choose the correct Medicare locality, and apply GPCI before reading a dollar estimate. The RVU calculator and GPCI calculator handle those steps together, while the salary calculator is the more relevant tool once the question shifts from “what does Medicare pay” to “what does this visit contribute to my compensation.”
A few factors commonly explain why a calculator estimate won’t match an actual remittance advice: sequestration reductions, MIPS payment adjustments applied at the practice or individual level, secondary payer coordination, bundled or global-period billing rules, and commercial payer fee schedules that reference but don’t duplicate the Medicare MPFS. None of those factors change the underlying RVU components — they change how the conversion factor and final allowed amount get applied on a specific claim.