CPT / HCPCS code · 2026 CMS data · Verified 2026-08-31
CPT 56800 RVU and Medicare Payment (2026)
Plastic repair introitus — 3.83 work RVU, about $227.13 non-facility Medicare payment at the 2026 conversion factor.
- Work RVU
- 3.83
- PE RVU (non-facility)
- 2.31
- PE RVU (facility)
- 2.31
- MP RVU
- 0.66
- Office payment
- $227.13
- Facility payment
- $227.13
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 56800 in a non-facility setting with national GPCI: (3.83 + 2.31 + 0.66) × $33.4009 ≈ $227.13. The same code in a facility setting pays about $227.13 because facility PE RVU (2.31) replaces office PE RVU.
What changes by locality
GPCI moves 56800 non-facility payment from $205.56 to $286.21 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 56800?
3.83. 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 56800 in 2026?
About $227.13 non-facility ($227.13 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 (3.83) and malpractice RVU stay fixed; only practice expense changes (2.31 office vs 2.31 facility). That is the entire office-vs-facility payment gap.