CPT / HCPCS code · 2026 CMS data · Verified 2026-08-31
CPT 40525 RVU and Medicare Payment (2026)
Reconstruct lip with flap — 7.53 work RVU, about $498.01 non-facility Medicare payment at the 2026 conversion factor.
- Work RVU
- 7.53
- PE RVU (non-facility)
- 6.18
- PE RVU (facility)
- 6.18
- MP RVU
- 1.2
- Office payment
- $498.01
- Facility payment
- $498.01
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 40525 in a non-facility setting with national GPCI: (7.53 + 6.18 + 1.2) × $33.4009 ≈ $498.01. The same code in a facility setting pays about $498.01 because facility PE RVU (6.18) replaces office PE RVU.
What changes by locality
GPCI moves 40525 non-facility payment from $449.46 to $619.18 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 40525?
7.53. 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 40525 in 2026?
About $498.01 non-facility ($498.01 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 (7.53) and malpractice RVU stay fixed; only practice expense changes (6.18 office vs 6.18 facility). That is the entire office-vs-facility payment gap.