CPT / HCPCS code · 2026 CMS data · Verified 2026-08-31
CPT 25628 RVU and Medicare Payment (2026)
Optx carpl scphd fx int fixj — 9.43 work RVU, about $669.02 non-facility Medicare payment at the 2026 conversion factor.
- Work RVU
- 9.43
- PE RVU (non-facility)
- 8.8
- PE RVU (facility)
- 8.8
- MP RVU
- 1.8
- Office payment
- $669.02
- Facility payment
- $669.02
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 25628 in a non-facility setting with national GPCI: (9.43 + 8.8 + 1.8) × $33.4009 ≈ $669.02. The same code in a facility setting pays about $669.02 because facility PE RVU (8.8) replaces office PE RVU.
What changes by locality
GPCI moves 25628 non-facility payment from $598.42 to $818.62 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 25628?
9.43. 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 25628 in 2026?
About $669.02 non-facility ($669.02 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 (9.43) and malpractice RVU stay fixed; only practice expense changes (8.8 office vs 8.8 facility). That is the entire office-vs-facility payment gap.