CPT / HCPCS code · 2026 CMS data · Verified 2026-08-31
CPT 49186 RVU and Medicare Payment (2026)
Opn exc/dstr ntra-abd 5 cm/ — 21.45 work RVU, about $1,221.47 non-facility Medicare payment at the 2026 conversion factor.
- Work RVU
- 21.45
- PE RVU (non-facility)
- 10.28
- PE RVU (facility)
- 10.28
- MP RVU
- 4.84
- Office payment
- $1,221.47
- Facility payment
- $1,221.47
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 49186 in a non-facility setting with national GPCI: (21.45 + 10.28 + 4.84) × $33.4009 ≈ $1,221.47. The same code in a facility setting pays about $1,221.47 because facility PE RVU (10.28) replaces office PE RVU.
What changes by locality
GPCI moves 49186 non-facility payment from $1,094.48 to $1,529.43 across CMS localities — from Nebraska 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 49186?
21.45. 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 49186 in 2026?
About $1,221.47 non-facility ($1,221.47 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 (21.45) and malpractice RVU stay fixed; only practice expense changes (10.28 office vs 10.28 facility). That is the entire office-vs-facility payment gap.