CPT / HCPCS code · 2026 CMS data · Verified 2026-08-31
CPT 31294 RVU and Medicare Payment (2026)
Nsl/sins ndsc surg on dcmprn — 19.8 work RVU, about $1,052.13 non-facility Medicare payment at the 2026 conversion factor.
- Work RVU
- 19.8
- PE RVU (non-facility)
- 8.8
- PE RVU (facility)
- 8.8
- MP RVU
- 2.9
- Office payment
- $1,052.13
- Facility payment
- $1,052.13
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 31294 in a non-facility setting with national GPCI: (19.8 + 8.8 + 2.9) × $33.4009 ≈ $1,052.13. The same code in a facility setting pays about $1,052.13 because facility PE RVU (8.8) replaces office PE RVU.
What changes by locality
GPCI moves 31294 non-facility payment from $963.71 to $1,358.41 across CMS localities — from Arkansas 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 31294?
19.8. 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 31294 in 2026?
About $1,052.13 non-facility ($1,052.13 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 (19.8) and malpractice RVU stay fixed; only practice expense changes (8.8 office vs 8.8 facility). That is the entire office-vs-facility payment gap.