CPT / HCPCS code · 2026 CMS data · Verified 2026-08-31
CPT 40520 RVU and Medicare Payment (2026)
Partial excision of lip — 4.67 work RVU, about $519.38 non-facility Medicare payment at the 2026 conversion factor.
- Work RVU
- 4.67
- PE RVU (non-facility)
- 10.16
- PE RVU (facility)
- 4.4
- MP RVU
- 0.72
- Office payment
- $519.38
- Facility payment
- $326.99
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 40520 in a non-facility setting with national GPCI: (4.67 + 10.16 + 0.72) × $33.4009 ≈ $519.38. The same code in a facility setting pays about $326.99 because facility PE RVU (4.4) replaces office PE RVU.
What changes by locality
GPCI moves 40520 non-facility payment from $459.87 to $675.38 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 40520?
4.67. 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 40520 in 2026?
About $519.38 non-facility ($326.99 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 (4.67) and malpractice RVU stay fixed; only practice expense changes (10.16 office vs 4.4 facility). That is the entire office-vs-facility payment gap.