CPT / HCPCS code · 2026 CMS data · Verified 2026-08-31
CPT 21315 RVU and Medicare Payment (2026)
Clsd tx nsl fx mnpj wo stblj — 0.94 work RVU, about $159.99 non-facility Medicare payment at the 2026 conversion factor.
- Work RVU
- 0.94
- PE RVU (non-facility)
- 3.69
- PE RVU (facility)
- 0.51
- MP RVU
- 0.16
- Office payment
- $159.99
- Facility payment
- $53.78
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 21315 in a non-facility setting with national GPCI: (0.94 + 3.69 + 0.16) × $33.4009 ≈ $159.99. The same code in a facility setting pays about $53.78 because facility PE RVU (0.51) replaces office PE RVU.
What changes by locality
GPCI moves 21315 non-facility payment from $140.02 to $215.44 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 21315?
0.94. 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 21315 in 2026?
About $159.99 non-facility ($53.78 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 (0.94) and malpractice RVU stay fixed; only practice expense changes (3.69 office vs 0.51 facility). That is the entire office-vs-facility payment gap.