CPT / HCPCS code · 2026 CMS data · Verified 2026-08-31
CPT 28054 RVU and Medicare Payment (2026)
Biopsy of toe joint lining — 3.48 work RVU, about $357.72 non-facility Medicare payment at the 2026 conversion factor.
- Work RVU
- 3.48
- PE RVU (non-facility)
- 6.94
- PE RVU (facility)
- 2.89
- MP RVU
- 0.29
- Office payment
- $357.72
- Facility payment
- $222.45
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 28054 in a non-facility setting with national GPCI: (3.48 + 6.94 + 0.29) × $33.4009 ≈ $357.72. The same code in a facility setting pays about $222.45 because facility PE RVU (2.89) replaces office PE RVU.
What changes by locality
GPCI moves 28054 non-facility payment from $320.34 to $468.47 across CMS localities — from Arkansas to San Jose-sunnyvale-santa Clara (san Benito Cnty). 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 28054?
3.48. 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 28054 in 2026?
About $357.72 non-facility ($222.45 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 (3.48) and malpractice RVU stay fixed; only practice expense changes (6.94 office vs 2.89 facility). That is the entire office-vs-facility payment gap.