CPT / HCPCS code · 2026 CMS data · Verified 2026-08-31
CPT 49491 RVU and Medicare Payment (2026)
Rpr hern preemie reduc — 12.22 work RVU, about $763.88 non-facility Medicare payment at the 2026 conversion factor.
- Work RVU
- 12.22
- PE RVU (non-facility)
- 7.39
- PE RVU (facility)
- 7.39
- MP RVU
- 3.26
- Office payment
- $763.88
- Facility payment
- $763.88
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 49491 in a non-facility setting with national GPCI: (12.22 + 7.39 + 3.26) × $33.4009 ≈ $763.88. The same code in a facility setting pays about $763.88 because facility PE RVU (7.39) replaces office PE RVU.
What changes by locality
GPCI moves 49491 non-facility payment from $676.27 to $940.49 across CMS localities — from Arkansas 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 49491?
12.22. 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 49491 in 2026?
About $763.88 non-facility ($763.88 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 (12.22) and malpractice RVU stay fixed; only practice expense changes (7.39 office vs 7.39 facility). That is the entire office-vs-facility payment gap.