CPT / HCPCS code · 2026 CMS data · Verified 2026-08-31
CPT 21255 RVU and Medicare Payment (2026)
Reconstruct lower jaw bone — 18 work RVU, about $1,221.14 non-facility Medicare payment at the 2026 conversion factor.
- Work RVU
- 18
- PE RVU (non-facility)
- 15.95
- PE RVU (facility)
- 15.95
- MP RVU
- 2.61
- Office payment
- $1,221.14
- Facility payment
- $1,221.14
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 21255 in a non-facility setting with national GPCI: (18 + 15.95 + 2.61) × $33.4009 ≈ $1,221.14. The same code in a facility setting pays about $1,221.14 because facility PE RVU (15.95) replaces office PE RVU.
What changes by locality
GPCI moves 21255 non-facility payment from $1,103.74 to $1,517.23 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 21255?
18. 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 21255 in 2026?
About $1,221.14 non-facility ($1,221.14 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 (18) and malpractice RVU stay fixed; only practice expense changes (15.95 office vs 15.95 facility). That is the entire office-vs-facility payment gap.