CPT / HCPCS code · 2026 CMS data · Verified 2026-08-31
CPT 21256 RVU and Medicare Payment (2026)
Reconstruction of orbit — 17.22 work RVU, about $1,114.92 non-facility Medicare payment at the 2026 conversion factor.
- Work RVU
- 17.22
- PE RVU (non-facility)
- 12.97
- PE RVU (facility)
- 12.97
- MP RVU
- 3.19
- Office payment
- $1,114.92
- Facility payment
- $1,114.92
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 21256 in a non-facility setting with national GPCI: (17.22 + 12.97 + 3.19) × $33.4009 ≈ $1,114.92. The same code in a facility setting pays about $1,114.92 because facility PE RVU (12.97) replaces office PE RVU.
What changes by locality
GPCI moves 21256 non-facility payment from $1,002.16 to $1,382.82 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 21256?
17.22. 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 21256 in 2026?
About $1,114.92 non-facility ($1,114.92 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 (17.22) and malpractice RVU stay fixed; only practice expense changes (12.97 office vs 12.97 facility). That is the entire office-vs-facility payment gap.