CPT / HCPCS code · 2026 CMS data · Verified 2026-08-31
CPT 45397 RVU and Medicare Payment (2026)
Lap remove rectum w/pouch — 35.59 work RVU, about $1,941.93 non-facility Medicare payment at the 2026 conversion factor.
- Work RVU
- 35.59
- PE RVU (non-facility)
- 16.39
- PE RVU (facility)
- 16.39
- MP RVU
- 6.16
- Office payment
- $1,941.93
- Facility payment
- $1,941.93
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 45397 in a non-facility setting with national GPCI: (35.59 + 16.39 + 6.16) × $33.4009 ≈ $1,941.93. The same code in a facility setting pays about $1,941.93 because facility PE RVU (16.39) replaces office PE RVU.
What changes by locality
GPCI moves 45397 non-facility payment from $1,764.95 to $2,479.5 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 45397?
35.59. 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 45397 in 2026?
About $1,941.93 non-facility ($1,941.93 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 (35.59) and malpractice RVU stay fixed; only practice expense changes (16.39 office vs 16.39 facility). That is the entire office-vs-facility payment gap.