CPT / HCPCS code · 2026 CMS data · Verified 2026-08-31
CPT 31254 RVU and Medicare Payment (2026)
Nsl/sins ndsc w/prtl ethmdct — 4.16 work RVU, about $436.55 non-facility Medicare payment at the 2026 conversion factor.
- Work RVU
- 4.16
- PE RVU (non-facility)
- 8.31
- PE RVU (facility)
- 1.4
- MP RVU
- 0.6
- Office payment
- $436.55
- Facility payment
- $205.75
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 31254 in a non-facility setting with national GPCI: (4.16 + 8.31 + 0.6) × $33.4009 ≈ $436.55. The same code in a facility setting pays about $205.75 because facility PE RVU (1.4) replaces office PE RVU.
What changes by locality
GPCI moves 31254 non-facility payment from $387.69 to $565.22 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 31254?
4.16. 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 31254 in 2026?
About $436.55 non-facility ($205.75 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 (4.16) and malpractice RVU stay fixed; only practice expense changes (8.31 office vs 1.4 facility). That is the entire office-vs-facility payment gap.