CPT / HCPCS code · 2026 CMS data · Verified 2026-08-31
CPT 21296 RVU and Medicare Payment (2026)
Revision of jaw muscle/bone — 4.66 work RVU, about $369.75 non-facility Medicare payment at the 2026 conversion factor.
- Work RVU
- 4.66
- PE RVU (non-facility)
- 5.74
- PE RVU (facility)
- 5.74
- MP RVU
- 0.67
- Office payment
- $369.75
- Facility payment
- $369.75
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 21296 in a non-facility setting with national GPCI: (4.66 + 5.74 + 0.67) × $33.4009 ≈ $369.75. The same code in a facility setting pays about $369.75 because facility PE RVU (5.74) replaces office PE RVU.
What changes by locality
GPCI moves 21296 non-facility payment from $331.86 to $461.23 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 21296?
4.66. 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 21296 in 2026?
About $369.75 non-facility ($369.75 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 (4.66) and malpractice RVU stay fixed; only practice expense changes (5.74 office vs 5.74 facility). That is the entire office-vs-facility payment gap.