CPT / HCPCS code · 2026 CMS data · Verified 2026-08-31
CPT 20251 RVU and Medicare Payment (2026)
Biopsy vrt bdy open lmbr/crv — 5.58 work RVU, about $421.19 non-facility Medicare payment at the 2026 conversion factor.
- Work RVU
- 5.58
- PE RVU (non-facility)
- 5.37
- PE RVU (facility)
- 5.37
- MP RVU
- 1.66
- Office payment
- $421.19
- Facility payment
- $421.19
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 20251 in a non-facility setting with national GPCI: (5.58 + 5.37 + 1.66) × $33.4009 ≈ $421.19. The same code in a facility setting pays about $421.19 because facility PE RVU (5.37) replaces office PE RVU.
What changes by locality
GPCI moves 20251 non-facility payment from $369 to $514.53 across CMS localities — from Arkansas to Nyc Suburbs/long Island. 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 20251?
5.58. 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 20251 in 2026?
About $421.19 non-facility ($421.19 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 (5.58) and malpractice RVU stay fixed; only practice expense changes (5.37 office vs 5.37 facility). That is the entire office-vs-facility payment gap.