CPT / HCPCS code · 2026 CMS data · Verified 2026-08-31
CPT 19101 RVU and Medicare Payment (2026)
Biopsy of breast open — 3.15 work RVU, about $350.38 non-facility Medicare payment at the 2026 conversion factor.
- Work RVU
- 3.15
- PE RVU (non-facility)
- 6.55
- PE RVU (facility)
- 2.54
- MP RVU
- 0.79
- Office payment
- $350.38
- Facility payment
- $216.44
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 19101 in a non-facility setting with national GPCI: (3.15 + 6.55 + 0.79) × $33.4009 ≈ $350.38. The same code in a facility setting pays about $216.44 because facility PE RVU (2.54) replaces office PE RVU.
What changes by locality
GPCI moves 19101 non-facility payment from $306.73 to $446.4 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 19101?
3.15. 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 19101 in 2026?
About $350.38 non-facility ($216.44 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 (3.15) and malpractice RVU stay fixed; only practice expense changes (6.55 office vs 2.54 facility). That is the entire office-vs-facility payment gap.