CPT / HCPCS code · 2026 CMS data · Verified 2026-08-31
CPT 21263 RVU and Medicare Payment (2026)
Revise eye sockets — 30.23 work RVU, about $2,020.75 non-facility Medicare payment at the 2026 conversion factor.
- Work RVU
- 30.23
- PE RVU (non-facility)
- 24.66
- PE RVU (facility)
- 24.66
- MP RVU
- 5.61
- Office payment
- $2,020.75
- Facility payment
- $2,020.75
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 21263 in a non-facility setting with national GPCI: (30.23 + 24.66 + 5.61) × $33.4009 ≈ $2,020.75. The same code in a facility setting pays about $2,020.75 because facility PE RVU (24.66) replaces office PE RVU.
What changes by locality
GPCI moves 21263 non-facility payment from $1,813.74 to $2,495.01 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 21263?
30.23. 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 21263 in 2026?
About $2,020.75 non-facility ($2,020.75 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 (30.23) and malpractice RVU stay fixed; only practice expense changes (24.66 office vs 24.66 facility). That is the entire office-vs-facility payment gap.