CPT / HCPCS code · 2026 CMS data · Verified 2026-08-31
CPT 21249 RVU and Medicare Payment (2026)
Reconstruction of jaw — 18.3 work RVU, about $1,404.51 non-facility Medicare payment at the 2026 conversion factor.
- Work RVU
- 18.3
- PE RVU (non-facility)
- 21.44
- PE RVU (facility)
- 9.64
- MP RVU
- 2.31
- Office payment
- $1,404.51
- Facility payment
- $1,010.38
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 21249 in a non-facility setting with national GPCI: (18.3 + 21.44 + 2.31) × $33.4009 ≈ $1,404.51. The same code in a facility setting pays about $1,010.38 because facility PE RVU (9.64) replaces office PE RVU.
What changes by locality
GPCI moves 21249 non-facility payment from $1,266.11 to $1,752.47 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 21249?
18.3. 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 21249 in 2026?
About $1,404.51 non-facility ($1,010.38 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 (18.3) and malpractice RVU stay fixed; only practice expense changes (21.44 office vs 9.64 facility). That is the entire office-vs-facility payment gap.