CPT / HCPCS code · 2026 CMS data · Verified 2026-08-31
CPT 65290 RVU and Medicare Payment (2026)
Repair of eye socket wound — 6.37 work RVU, about $415.17 non-facility Medicare payment at the 2026 conversion factor.
- Work RVU
- 6.37
- PE RVU (non-facility)
- 5.57
- PE RVU (facility)
- 5.57
- MP RVU
- 0.49
- Office payment
- $415.17
- Facility payment
- $415.17
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 65290 in a non-facility setting with national GPCI: (6.37 + 5.57 + 0.49) × $33.4009 ≈ $415.17. The same code in a facility setting pays about $415.17 because facility PE RVU (5.57) replaces office PE RVU.
What changes by locality
GPCI moves 65290 non-facility payment from $381 to $526.3 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 65290?
6.37. 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 65290 in 2026?
About $415.17 non-facility ($415.17 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 (6.37) and malpractice RVU stay fixed; only practice expense changes (5.57 office vs 5.57 facility). That is the entire office-vs-facility payment gap.