CPT / HCPCS code · 2026 CMS data · Verified 2026-08-31
CPT 78804 RVU and Medicare Payment (2026)
Rp loclzj tum whbdy 2+d img — 0.98 work RVU, about $561.14 non-facility Medicare payment at the 2026 conversion factor.
- Work RVU
- 0.98
- PE RVU (non-facility)
- 15.69
- PE RVU (facility)
- 15.69
- MP RVU
- 0.13
- Office payment
- $561.14
- Facility payment
- $561.14
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 78804 in a non-facility setting with national GPCI: (0.98 + 15.69 + 0.13) × $33.4009 ≈ $561.14. The same code in a facility setting pays about $561.14 because facility PE RVU (15.69) replaces office PE RVU.
What changes by locality
GPCI moves 78804 non-facility payment from $485.14 to $794.36 across CMS localities — from Arkansas to San Jose-sunnyvale-santa Clara (san Benito Cnty). 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 78804?
0.98. 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 78804 in 2026?
About $561.14 non-facility ($561.14 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 (0.98) and malpractice RVU stay fixed; only practice expense changes (15.69 office vs 15.69 facility). That is the entire office-vs-facility payment gap.