CPT / HCPCS code · 2026 CMS data · Verified 2026-08-31
CPT 31259 RVU and Medicare Payment (2026)
Nsl/sins ndsc sphn tiss rmvl — 8.27 work RVU, about $397.14 non-facility Medicare payment at the 2026 conversion factor.
- Work RVU
- 8.27
- PE RVU (non-facility)
- 2.4
- PE RVU (facility)
- 2.4
- MP RVU
- 1.22
- Office payment
- $397.14
- Facility payment
- $397.14
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 31259 in a non-facility setting with national GPCI: (8.27 + 2.4 + 1.22) × $33.4009 ≈ $397.14. The same code in a facility setting pays about $397.14 because facility PE RVU (2.4) replaces office PE RVU.
What changes by locality
GPCI moves 31259 non-facility payment from $365.57 to $522.16 across CMS localities — from Wisconsin 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 31259?
8.27. 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 31259 in 2026?
About $397.14 non-facility ($397.14 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 (8.27) and malpractice RVU stay fixed; only practice expense changes (2.4 office vs 2.4 facility). That is the entire office-vs-facility payment gap.