CPT / HCPCS code · 2026 CMS data · Verified 2026-08-31
CPT 21011 RVU and Medicare Payment (2026)
Exc face les sc — 2.92 work RVU, about $395.13 non-facility Medicare payment at the 2026 conversion factor.
- Work RVU
- 2.92
- PE RVU (non-facility)
- 8.38
- PE RVU (facility)
- 4.04
- MP RVU
- 0.53
- Office payment
- $395.13
- Facility payment
- $250.17
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 21011 in a non-facility setting with national GPCI: (2.92 + 8.38 + 0.53) × $33.4009 ≈ $395.13. The same code in a facility setting pays about $250.17 because facility PE RVU (4.04) replaces office PE RVU.
What changes by locality
GPCI moves 21011 non-facility payment from $347.08 to $521.36 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 21011?
2.92. 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 21011 in 2026?
About $395.13 non-facility ($250.17 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 (2.92) and malpractice RVU stay fixed; only practice expense changes (8.38 office vs 4.04 facility). That is the entire office-vs-facility payment gap.