CPT / HCPCS code · 2026 CMS data · Verified 2026-08-31
CPT 19355 RVU and Medicare Payment (2026)
Correct inverted nipple(s) — 8.31 work RVU, about $813.98 non-facility Medicare payment at the 2026 conversion factor.
- Work RVU
- 8.31
- PE RVU (non-facility)
- 14.53
- PE RVU (facility)
- 6.99
- MP RVU
- 1.53
- Office payment
- $813.98
- Facility payment
- $562.14
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 19355 in a non-facility setting with national GPCI: (8.31 + 14.53 + 1.53) × $33.4009 ≈ $813.98. The same code in a facility setting pays about $562.14 because facility PE RVU (6.99) replaces office PE RVU.
What changes by locality
GPCI moves 19355 non-facility payment from $720.77 to $1,035.31 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 19355?
8.31. 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 19355 in 2026?
About $813.98 non-facility ($562.14 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 (8.31) and malpractice RVU stay fixed; only practice expense changes (14.53 office vs 6.99 facility). That is the entire office-vs-facility payment gap.