CPT / HCPCS code · 2026 CMS data · Verified 2026-08-31
CPT 11104 RVU and Medicare Payment (2026)
Punch bx skin single lesion — 0.81 work RVU, about $121.25 non-facility Medicare payment at the 2026 conversion factor.
- Work RVU
- 0.81
- PE RVU (non-facility)
- 2.73
- PE RVU (facility)
- 0.24
- MP RVU
- 0.09
- Office payment
- $121.25
- Facility payment
- $38.08
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 11104 in a non-facility setting with national GPCI: (0.81 + 2.73 + 0.09) × $33.4009 ≈ $121.25. The same code in a facility setting pays about $38.08 because facility PE RVU (0.24) replaces office PE RVU.
What changes by locality
GPCI moves 11104 non-facility payment from $106.93 to $163.13 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 11104?
0.81. 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 11104 in 2026?
About $121.25 non-facility ($38.08 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 (0.81) and malpractice RVU stay fixed; only practice expense changes (2.73 office vs 0.24 facility). That is the entire office-vs-facility payment gap.