CPT / HCPCS code · 2026 CMS data · Verified 2026-08-31
CPT 69604 RVU and Medicare Payment (2026)
Revj mstdc rsltg tympanplsty — 13.85 work RVU, about $986.33 non-facility Medicare payment at the 2026 conversion factor.
- Work RVU
- 13.85
- PE RVU (non-facility)
- 13.66
- PE RVU (facility)
- 13.66
- MP RVU
- 2.02
- Office payment
- $986.33
- Facility payment
- $986.33
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 69604 in a non-facility setting with national GPCI: (13.85 + 13.66 + 2.02) × $33.4009 ≈ $986.33. The same code in a facility setting pays about $986.33 because facility PE RVU (13.66) replaces office PE RVU.
What changes by locality
GPCI moves 69604 non-facility payment from $889.27 to $1,216.99 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 69604?
13.85. 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 69604 in 2026?
About $986.33 non-facility ($986.33 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 (13.85) and malpractice RVU stay fixed; only practice expense changes (13.66 office vs 13.66 facility). That is the entire office-vs-facility payment gap.