CPT / HCPCS code · 2026 CMS data · Verified 2026-08-31
CPT 11055 RVU and Medicare Payment (2026)
Paring/cutg b9 hyprker les 1 — 0.34 work RVU, about $70.14 non-facility Medicare payment at the 2026 conversion factor.
- Work RVU
- 0.34
- PE RVU (non-facility)
- 1.73
- PE RVU (facility)
- 0.04
- MP RVU
- 0.03
- Office payment
- $70.14
- Facility payment
- $13.69
How the payment is calculated
Total RVU is work plus practice expense plus malpractice, each adjusted by its GPCI factor, then multiplied by the conversion factor. For 11055 in a non-facility setting with national GPCI: (0.34 + 1.73 + 0.03) × $33.4009 ≈ $70.14. The same code in a facility setting pays about $13.69 because facility PE RVU (0.04) replaces office PE RVU.
What changes by locality
GPCI moves 11055 non-facility payment from $61.51 to $96.47 across CMS localities — from Arkansas to San Jose-sunnyvale-santa Clara (san Benito Cnty). Check your exact locality in the GPCI calculator rather than using a state average.
Related codes
Checking a different code or locality? Open the full RVU calculator to run any of the 7,790 CPT/HCPCS codes with your own GPCI factors.
Frequently asked questions
What is the 2026 work RVU for CPT 11055?
0.34. Work RVU measures physician time, skill, and intensity — it does not change by setting or locality. Total payment adds practice expense and malpractice RVUs plus the conversion factor.
How much does Medicare pay for CPT 11055 in 2026?
About $70.14 non-facility ($13.69 facility) at national GPCI with the 2026 $33.4009 conversion factor. Your locality GPCI moves the number — see the range above.
Does the work RVU change between office and facility?
No. Work RVU (0.34) and malpractice RVU stay fixed; only practice expense changes (1.73 office vs 0.04 facility). That is the entire office-vs-facility payment gap.