CPT / HCPCS code · 2026 CMS data · Verified 2026-08-31
CPT 46258 RVU and Medicare Payment (2026)
Remove in/ex hem grp w/fistu — 6.25 work RVU, about $480.97 non-facility Medicare payment at the 2026 conversion factor.
- Work RVU
- 6.25
- PE RVU (non-facility)
- 6.48
- PE RVU (facility)
- 6.48
- MP RVU
- 1.67
- Office payment
- $480.97
- Facility payment
- $480.97
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 46258 in a non-facility setting with national GPCI: (6.25 + 6.48 + 1.67) × $33.4009 ≈ $480.97. The same code in a facility setting pays about $480.97 because facility PE RVU (6.48) replaces office PE RVU.
What changes by locality
GPCI moves 46258 non-facility payment from $423.4 to $583.04 across CMS localities — from Arkansas to Nyc Suburbs/long Island. 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 46258?
6.25. 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 46258 in 2026?
About $480.97 non-facility ($480.97 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 (6.25) and malpractice RVU stay fixed; only practice expense changes (6.48 office vs 6.48 facility). That is the entire office-vs-facility payment gap.