CPT / HCPCS code · 2026 CMS data · Verified 2026-08-31
CPT 53865 RVU and Medicare Payment (2026)
Cysto insj dev ischmc rmdlg — 3.02 work RVU, about $3,086.58 non-facility Medicare payment at the 2026 conversion factor.
- Work RVU
- 3.02
- PE RVU (non-facility)
- 89
- PE RVU (facility)
- 0.95
- MP RVU
- 0.39
- Office payment
- $3,086.58
- Facility payment
- $145.63
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 53865 in a non-facility setting with national GPCI: (3.02 + 89 + 0.39) × $33.4009 ≈ $3,086.58. The same code in a facility setting pays about $145.63 because facility PE RVU (0.95) replaces office PE RVU.
What changes by locality
GPCI moves 53865 non-facility payment from $2,661.11 to $4,405.55 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 53865?
3.02. 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 53865 in 2026?
About $3,086.58 non-facility ($145.63 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 (3.02) and malpractice RVU stay fixed; only practice expense changes (89 office vs 0.95 facility). That is the entire office-vs-facility payment gap.