CPT / HCPCS code · 2026 CMS data · Verified 2026-08-31
CPT 54865 RVU and Medicare Payment (2026)
Explore epididymis — 5.63 work RVU, about $336.01 non-facility Medicare payment at the 2026 conversion factor.
- Work RVU
- 5.63
- PE RVU (non-facility)
- 3.71
- PE RVU (facility)
- 3.71
- MP RVU
- 0.72
- Office payment
- $336.01
- Facility payment
- $336.01
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 54865 in a non-facility setting with national GPCI: (5.63 + 3.71 + 0.72) × $33.4009 ≈ $336.01. The same code in a facility setting pays about $336.01 because facility PE RVU (3.71) replaces office PE RVU.
What changes by locality
GPCI moves 54865 non-facility payment from $306.88 to $427.29 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 54865?
5.63. 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 54865 in 2026?
About $336.01 non-facility ($336.01 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 (5.63) and malpractice RVU stay fixed; only practice expense changes (3.71 office vs 3.71 facility). That is the entire office-vs-facility payment gap.