CPT / HCPCS code · 2026 CMS data · Verified 2026-08-31
CPT 19126 RVU and Medicare Payment (2026)
Excision addl breast lesion — 2.86 work RVU, about $143.96 non-facility Medicare payment at the 2026 conversion factor.
- Work RVU
- 2.86
- PE RVU (non-facility)
- 0.72
- PE RVU (facility)
- 0.72
- MP RVU
- 0.73
- Office payment
- $143.96
- Facility payment
- $143.96
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 19126 in a non-facility setting with national GPCI: (2.86 + 0.72 + 0.73) × $33.4009 ≈ $143.96. The same code in a facility setting pays about $143.96 because facility PE RVU (0.72) replaces office PE RVU.
What changes by locality
GPCI moves 19126 non-facility payment from $126.08 to $182.34 across CMS localities — from Wisconsin to Alaska. 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 19126?
2.86. 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 19126 in 2026?
About $143.96 non-facility ($143.96 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 (2.86) and malpractice RVU stay fixed; only practice expense changes (0.72 office vs 0.72 facility). That is the entire office-vs-facility payment gap.