CPT / HCPCS code · 2026 CMS data · Verified 2026-08-31
CPT 55200 RVU and Medicare Payment (2026)
Incision of sperm duct — 4.44 work RVU, about $395.13 non-facility Medicare payment at the 2026 conversion factor.
- Work RVU
- 4.44
- PE RVU (non-facility)
- 6.83
- PE RVU (facility)
- 2.73
- MP RVU
- 0.56
- Office payment
- $395.13
- Facility payment
- $258.19
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 55200 in a non-facility setting with national GPCI: (4.44 + 6.83 + 0.56) × $33.4009 ≈ $395.13. The same code in a facility setting pays about $258.19 because facility PE RVU (2.73) replaces office PE RVU.
What changes by locality
GPCI moves 55200 non-facility payment from $353.89 to $503.6 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 55200?
4.44. 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 55200 in 2026?
About $395.13 non-facility ($258.19 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 (4.44) and malpractice RVU stay fixed; only practice expense changes (6.83 office vs 2.73 facility). That is the entire office-vs-facility payment gap.