CPT / HCPCS code · 2026 CMS data · Verified 2026-08-31
CPT 21435 RVU and Medicare Payment (2026)
Optx crnfc sep comp int&/xtr — 19.75 work RVU, about $1,261.55 non-facility Medicare payment at the 2026 conversion factor.
- Work RVU
- 19.75
- PE RVU (non-facility)
- 14.36
- PE RVU (facility)
- 14.36
- MP RVU
- 3.66
- Office payment
- $1,261.55
- Facility payment
- $1,261.55
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 21435 in a non-facility setting with national GPCI: (19.75 + 14.36 + 3.66) × $33.4009 ≈ $1,261.55. The same code in a facility setting pays about $1,261.55 because facility PE RVU (14.36) replaces office PE RVU.
What changes by locality
GPCI moves 21435 non-facility payment from $1,134.63 to $1,567.67 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 21435?
19.75. 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 21435 in 2026?
About $1,261.55 non-facility ($1,261.55 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 (19.75) and malpractice RVU stay fixed; only practice expense changes (14.36 office vs 14.36 facility). That is the entire office-vs-facility payment gap.