CPT / HCPCS code · 2026 CMS data · Verified 2026-08-31
CPT 21422 RVU and Medicare Payment (2026)
Optx palatal/max fracture — 8.51 work RVU, about $590.19 non-facility Medicare payment at the 2026 conversion factor.
- Work RVU
- 8.51
- PE RVU (non-facility)
- 7.92
- PE RVU (facility)
- 7.92
- MP RVU
- 1.24
- Office payment
- $590.19
- Facility payment
- $590.19
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 21422 in a non-facility setting with national GPCI: (8.51 + 7.92 + 1.24) × $33.4009 ≈ $590.19. The same code in a facility setting pays about $590.19 because facility PE RVU (7.92) replaces office PE RVU.
What changes by locality
GPCI moves 21422 non-facility payment from $532.81 to $730.91 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 21422?
8.51. 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 21422 in 2026?
About $590.19 non-facility ($590.19 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 (8.51) and malpractice RVU stay fixed; only practice expense changes (7.92 office vs 7.92 facility). That is the entire office-vs-facility payment gap.