CPT / HCPCS code · 2026 CMS data · Verified 2026-08-31
CPT 52204 RVU and Medicare Payment (2026)
Cystoscopy w/biopsy(s) — 2.53 work RVU, about $355.39 non-facility Medicare payment at the 2026 conversion factor.
- Work RVU
- 2.53
- PE RVU (non-facility)
- 7.77
- PE RVU (facility)
- 0.93
- MP RVU
- 0.34
- Office payment
- $355.39
- Facility payment
- $126.92
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 52204 in a non-facility setting with national GPCI: (2.53 + 7.77 + 0.34) × $33.4009 ≈ $355.39. The same code in a facility setting pays about $126.92 because facility PE RVU (0.93) replaces office PE RVU.
What changes by locality
GPCI moves 52204 non-facility payment from $313.28 to $474.12 across CMS localities — from Arkansas to San Jose-sunnyvale-santa Clara (san Benito Cnty). 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 52204?
2.53. 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 52204 in 2026?
About $355.39 non-facility ($126.92 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 (2.53) and malpractice RVU stay fixed; only practice expense changes (7.77 office vs 0.93 facility). That is the entire office-vs-facility payment gap.