CPT / HCPCS code · 2026 CMS data · Verified 2026-08-31
CPT 21811 RVU and Medicare Payment (2026)
Optx of rib fx w/fixj scope — 10.52 work RVU, about $544.77 non-facility Medicare payment at the 2026 conversion factor.
- Work RVU
- 10.52
- PE RVU (non-facility)
- 3.19
- PE RVU (facility)
- 3.19
- MP RVU
- 2.6
- Office payment
- $544.77
- Facility payment
- $544.77
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 21811 in a non-facility setting with national GPCI: (10.52 + 3.19 + 2.6) × $33.4009 ≈ $544.77. The same code in a facility setting pays about $544.77 because facility PE RVU (3.19) replaces office PE RVU.
What changes by locality
GPCI moves 21811 non-facility payment from $480.2 to $688.39 across CMS localities — from Wisconsin 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 21811?
10.52. 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 21811 in 2026?
About $544.77 non-facility ($544.77 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 (10.52) and malpractice RVU stay fixed; only practice expense changes (3.19 office vs 3.19 facility). That is the entire office-vs-facility payment gap.