CPT / HCPCS code · 2026 CMS data · Verified 2026-08-31
CPT 31235 RVU and Medicare Payment (2026)
Nsl/sins ndsc dx sphn sinusc — 2.57 work RVU, about $310.29 non-facility Medicare payment at the 2026 conversion factor.
- Work RVU
- 2.57
- PE RVU (non-facility)
- 6.35
- PE RVU (facility)
- 1.19
- MP RVU
- 0.37
- Office payment
- $310.29
- Facility payment
- $137.95
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 31235 in a non-facility setting with national GPCI: (2.57 + 6.35 + 0.37) × $33.4009 ≈ $310.29. The same code in a facility setting pays about $137.95 because facility PE RVU (1.19) replaces office PE RVU.
What changes by locality
GPCI moves 31235 non-facility payment from $274.4 to $407.75 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 31235?
2.57. 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 31235 in 2026?
About $310.29 non-facility ($137.95 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 (2.57) and malpractice RVU stay fixed; only practice expense changes (6.35 office vs 1.19 facility). That is the entire office-vs-facility payment gap.