CPT / HCPCS code · 2026 CMS data · Verified 2026-08-31
CPT 31257 RVU and Medicare Payment (2026)
Nsl/sins ndsc tot w/sphendt — 7.8 work RVU, about $375.09 non-facility Medicare payment at the 2026 conversion factor.
- Work RVU
- 7.8
- PE RVU (non-facility)
- 2.29
- PE RVU (facility)
- 2.29
- MP RVU
- 1.14
- Office payment
- $375.09
- Facility payment
- $375.09
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 31257 in a non-facility setting with national GPCI: (7.8 + 2.29 + 1.14) × $33.4009 ≈ $375.09. The same code in a facility setting pays about $375.09 because facility PE RVU (2.29) replaces office PE RVU.
What changes by locality
GPCI moves 31257 non-facility payment from $345.52 to $493.23 across CMS localities — from Nebraska 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 31257?
7.8. 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 31257 in 2026?
About $375.09 non-facility ($375.09 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 (7.8) and malpractice RVU stay fixed; only practice expense changes (2.29 office vs 2.29 facility). That is the entire office-vs-facility payment gap.