CPT / HCPCS code · 2026 CMS data · Verified 2026-08-31
CPT 55869 RVU and Medicare Payment (2026)
Lap srg prst8ct bi pl lmphad — 27.41 work RVU, about $1,328.69 non-facility Medicare payment at the 2026 conversion factor.
- Work RVU
- 27.41
- PE RVU (non-facility)
- 8.82
- PE RVU (facility)
- 8.82
- MP RVU
- 3.55
- Office payment
- $1,328.69
- Facility payment
- $1,328.69
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 55869 in a non-facility setting with national GPCI: (27.41 + 8.82 + 3.55) × $33.4009 ≈ $1,328.69. The same code in a facility setting pays about $1,328.69 because facility PE RVU (8.82) replaces office PE RVU.
What changes by locality
GPCI moves 55869 non-facility payment from $1,229.64 to $1,752.36 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 55869?
27.41. 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 55869 in 2026?
About $1,328.69 non-facility ($1,328.69 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 (27.41) and malpractice RVU stay fixed; only practice expense changes (8.82 office vs 8.82 facility). That is the entire office-vs-facility payment gap.