CPT / HCPCS code · 2026 CMS data · Verified 2026-08-31
CPT 20938 RVU and Medicare Payment (2026)
Sp bone agrft struct add-on — 2.94 work RVU, about $163.33 non-facility Medicare payment at the 2026 conversion factor.
- Work RVU
- 2.94
- PE RVU (non-facility)
- 0.99
- PE RVU (facility)
- 0.99
- MP RVU
- 0.96
- Office payment
- $163.33
- Facility payment
- $163.33
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 20938 in a non-facility setting with national GPCI: (2.94 + 0.99 + 0.96) × $33.4009 ≈ $163.33. The same code in a facility setting pays about $163.33 because facility PE RVU (0.99) replaces office PE RVU.
What changes by locality
GPCI moves 20938 non-facility payment from $139.75 to $213.71 across CMS localities — from Wisconsin to Miami. 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 20938?
2.94. 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 20938 in 2026?
About $163.33 non-facility ($163.33 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 (2.94) and malpractice RVU stay fixed; only practice expense changes (0.99 office vs 0.99 facility). That is the entire office-vs-facility payment gap.