CPT / HCPCS code · 2026 CMS data · Verified 2026-08-31
CPT 21194 RVU and Medicare Payment (2026)
Reconst lwr jaw w/graft — 21.27 work RVU, about $1,279.59 non-facility Medicare payment at the 2026 conversion factor.
- Work RVU
- 21.27
- PE RVU (non-facility)
- 13.97
- PE RVU (facility)
- 13.97
- MP RVU
- 3.07
- Office payment
- $1,279.59
- Facility payment
- $1,279.59
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 21194 in a non-facility setting with national GPCI: (21.27 + 13.97 + 3.07) × $33.4009 ≈ $1,279.59. The same code in a facility setting pays about $1,279.59 because facility PE RVU (13.97) replaces office PE RVU.
What changes by locality
GPCI moves 21194 non-facility payment from $1,164.06 to $1,619.1 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 21194?
21.27. 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 21194 in 2026?
About $1,279.59 non-facility ($1,279.59 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 (21.27) and malpractice RVU stay fixed; only practice expense changes (13.97 office vs 13.97 facility). That is the entire office-vs-facility payment gap.