CPT / HCPCS code · 2026 CMS data · Verified 2026-08-31
CPT 54861 RVU and Medicare Payment (2026)
Removal of epididymis — 9.46 work RVU, about $520.05 non-facility Medicare payment at the 2026 conversion factor.
- Work RVU
- 9.46
- PE RVU (non-facility)
- 4.89
- PE RVU (facility)
- 4.89
- MP RVU
- 1.22
- Office payment
- $520.05
- Facility payment
- $520.05
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 54861 in a non-facility setting with national GPCI: (9.46 + 4.89 + 1.22) × $33.4009 ≈ $520.05. The same code in a facility setting pays about $520.05 because facility PE RVU (4.89) replaces office PE RVU.
What changes by locality
GPCI moves 54861 non-facility payment from $477.26 to $670.36 across CMS localities — from Arkansas 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 54861?
9.46. 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 54861 in 2026?
About $520.05 non-facility ($520.05 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 (9.46) and malpractice RVU stay fixed; only practice expense changes (4.89 office vs 4.89 facility). That is the entire office-vs-facility payment gap.