CPT / HCPCS code · 2026 CMS data · Verified 2026-08-31
CPT 21813 RVU and Medicare Payment (2026)
Treatment of rib fracture — 17.17 work RVU, about $891.47 non-facility Medicare payment at the 2026 conversion factor.
- Work RVU
- 17.17
- PE RVU (non-facility)
- 4.92
- PE RVU (facility)
- 4.92
- MP RVU
- 4.6
- Office payment
- $891.47
- Facility payment
- $891.47
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 21813 in a non-facility setting with national GPCI: (17.17 + 4.92 + 4.6) × $33.4009 ≈ $891.47. The same code in a facility setting pays about $891.47 because facility PE RVU (4.92) replaces office PE RVU.
What changes by locality
GPCI moves 21813 non-facility payment from $778.25 to $1,133.13 across CMS localities — from Wisconsin to Miami. 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 21813?
17.17. 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 21813 in 2026?
About $891.47 non-facility ($891.47 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 (17.17) and malpractice RVU stay fixed; only practice expense changes (4.92 office vs 4.92 facility). That is the entire office-vs-facility payment gap.