CPT / HCPCS code · 2026 CMS data · Verified 2026-08-31
CPT 21365 RVU and Medicare Payment (2026)
Opn tx complx malar fx — 16.35 work RVU, about $962.61 non-facility Medicare payment at the 2026 conversion factor.
- Work RVU
- 16.35
- PE RVU (non-facility)
- 9.88
- PE RVU (facility)
- 9.88
- MP RVU
- 2.59
- Office payment
- $962.61
- Facility payment
- $962.61
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 21365 in a non-facility setting with national GPCI: (16.35 + 9.88 + 2.59) × $33.4009 ≈ $962.61. The same code in a facility setting pays about $962.61 because facility PE RVU (9.88) replaces office PE RVU.
What changes by locality
GPCI moves 21365 non-facility payment from $874.13 to $1,218.27 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 21365?
16.35. 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 21365 in 2026?
About $962.61 non-facility ($962.61 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 (16.35) and malpractice RVU stay fixed; only practice expense changes (9.88 office vs 9.88 facility). That is the entire office-vs-facility payment gap.