CPT / HCPCS code · 2026 CMS data · Verified 2026-08-31
CPT 45800 RVU and Medicare Payment (2026)
Repair rect/bladder fistula — 19.8 work RVU, about $1,209.45 non-facility Medicare payment at the 2026 conversion factor.
- Work RVU
- 19.8
- PE RVU (non-facility)
- 11.12
- PE RVU (facility)
- 11.12
- MP RVU
- 5.29
- Office payment
- $1,209.45
- Facility payment
- $1,209.45
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 45800 in a non-facility setting with national GPCI: (19.8 + 11.12 + 5.29) × $33.4009 ≈ $1,209.45. The same code in a facility setting pays about $1,209.45 because facility PE RVU (11.12) replaces office PE RVU.
What changes by locality
GPCI moves 45800 non-facility payment from $1,070.95 to $1,494.83 across CMS localities — from Nebraska to Miami. 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 45800?
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 45800 in 2026?
About $1,209.45 non-facility ($1,209.45 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 (11.12 office vs 11.12 facility). That is the entire office-vs-facility payment gap.