CPT / HCPCS code · 2026 CMS data · Verified 2026-08-31
CPT 25609 RVU and Medicare Payment (2026)
Optx dst rd xart fx/ep sep3+ — 14.02 work RVU, about $968.29 non-facility Medicare payment at the 2026 conversion factor.
- Work RVU
- 14.02
- PE RVU (non-facility)
- 12.22
- PE RVU (facility)
- 12.22
- MP RVU
- 2.75
- Office payment
- $968.29
- Facility payment
- $968.29
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 25609 in a non-facility setting with national GPCI: (14.02 + 12.22 + 2.75) × $33.4009 ≈ $968.29. The same code in a facility setting pays about $968.29 because facility PE RVU (12.22) replaces office PE RVU.
What changes by locality
GPCI moves 25609 non-facility payment from $866.19 to $1,187.72 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 25609?
14.02. 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 25609 in 2026?
About $968.29 non-facility ($968.29 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 (14.02) and malpractice RVU stay fixed; only practice expense changes (12.22 office vs 12.22 facility). That is the entire office-vs-facility payment gap.