CPT / HCPCS code · 2026 CMS data · Verified 2026-08-31
CPT 21159 RVU and Medicare Payment (2026)
Rcnst mdfc lfrtiii advm wo i — 42.06 work RVU, about $2,210.14 non-facility Medicare payment at the 2026 conversion factor.
- Work RVU
- 42.06
- PE RVU (non-facility)
- 17.96
- PE RVU (facility)
- 17.96
- MP RVU
- 6.15
- Office payment
- $2,210.14
- Facility payment
- $2,210.14
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 21159 in a non-facility setting with national GPCI: (42.06 + 17.96 + 6.15) × $33.4009 ≈ $2,210.14. The same code in a facility setting pays about $2,210.14 because facility PE RVU (17.96) replaces office PE RVU.
What changes by locality
GPCI moves 21159 non-facility payment from $2,025.93 to $2,859.32 across CMS localities — from Arkansas to Alaska. 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 21159?
42.06. 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 21159 in 2026?
About $2,210.14 non-facility ($2,210.14 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 (42.06) and malpractice RVU stay fixed; only practice expense changes (17.96 office vs 17.96 facility). That is the entire office-vs-facility payment gap.