CPT / HCPCS code · 2026 CMS data · Verified 2026-08-31
CPT 66225 RVU and Medicare Payment (2026)
Repair/graft eye lesion — 12.31 work RVU, about $793.27 non-facility Medicare payment at the 2026 conversion factor.
- Work RVU
- 12.31
- PE RVU (non-facility)
- 10.44
- PE RVU (facility)
- 10.44
- MP RVU
- 1
- Office payment
- $793.27
- Facility payment
- $793.27
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 66225 in a non-facility setting with national GPCI: (12.31 + 10.44 + 1) × $33.4009 ≈ $793.27. The same code in a facility setting pays about $793.27 because facility PE RVU (10.44) replaces office PE RVU.
What changes by locality
GPCI moves 66225 non-facility payment from $727.9 to $1,006.52 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 66225?
12.31. 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 66225 in 2026?
About $793.27 non-facility ($793.27 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 (12.31) and malpractice RVU stay fixed; only practice expense changes (10.44 office vs 10.44 facility). That is the entire office-vs-facility payment gap.