CPT / HCPCS code · 2026 CMS data · Verified 2026-08-31
CPT 63685 RVU and Medicare Payment (2026)
Ins/rplc spi npg/rcvr pocket — 5.06 work RVU, about $318.64 non-facility Medicare payment at the 2026 conversion factor.
- Work RVU
- 5.06
- PE RVU (non-facility)
- 3.43
- PE RVU (facility)
- 3.43
- MP RVU
- 1.05
- Office payment
- $318.64
- Facility payment
- $318.64
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 63685 in a non-facility setting with national GPCI: (5.06 + 3.43 + 1.05) × $33.4009 ≈ $318.64. The same code in a facility setting pays about $318.64 because facility PE RVU (3.43) replaces office PE RVU.
What changes by locality
GPCI moves 63685 non-facility payment from $285.48 to $394.85 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 63685?
5.06. 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 63685 in 2026?
About $318.64 non-facility ($318.64 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 (5.06) and malpractice RVU stay fixed; only practice expense changes (3.43 office vs 3.43 facility). That is the entire office-vs-facility payment gap.