CPT / HCPCS code · 2026 CMS data · Verified 2026-08-31
CPT 80504 RVU and Medicare Payment (2026)
Path clin consltj mod 21-40 — 0.91 work RVU, about $51.1 non-facility Medicare payment at the 2026 conversion factor.
- Work RVU
- 0.91
- PE RVU (non-facility)
- 0.57
- PE RVU (facility)
- 0.2
- MP RVU
- 0.05
- Office payment
- $51.1
- Facility payment
- $38.75
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 80504 in a non-facility setting with national GPCI: (0.91 + 0.57 + 0.05) × $33.4009 ≈ $51.1. The same code in a facility setting pays about $38.75 because facility PE RVU (0.2) replaces office PE RVU.
What changes by locality
GPCI moves 80504 non-facility payment from $47.61 to $66.79 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 80504?
0.91. 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 80504 in 2026?
About $51.1 non-facility ($38.75 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 (0.91) and malpractice RVU stay fixed; only practice expense changes (0.57 office vs 0.2 facility). That is the entire office-vs-facility payment gap.