CPT / HCPCS code · 2026 CMS data · Verified 2026-08-31
CPT 21125 RVU and Medicare Payment (2026)
Augmentation mndblr prostc — 10.53 work RVU, about $2,595.58 non-facility Medicare payment at the 2026 conversion factor.
- Work RVU
- 10.53
- PE RVU (non-facility)
- 65.97
- PE RVU (facility)
- 6.39
- MP RVU
- 1.21
- Office payment
- $2,595.58
- Facility payment
- $605.56
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 21125 in a non-facility setting with national GPCI: (10.53 + 65.97 + 1.21) × $33.4009 ≈ $2,595.58. The same code in a facility setting pays about $605.56 because facility PE RVU (6.39) replaces office PE RVU.
What changes by locality
GPCI moves 21125 non-facility payment from $2,265.3 to $3,589.45 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 21125?
10.53. 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 21125 in 2026?
About $2,595.58 non-facility ($605.56 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 (10.53) and malpractice RVU stay fixed; only practice expense changes (65.97 office vs 6.39 facility). That is the entire office-vs-facility payment gap.