CPT / HCPCS code · 2026 CMS data · Verified 2026-08-31
CPT 90865 RVU and Medicare Payment (2026)
Narcosynthesis — 2.84 work RVU, about $170.68 non-facility Medicare payment at the 2026 conversion factor.
- Work RVU
- 2.84
- PE RVU (non-facility)
- 2.14
- PE RVU (facility)
- 0.46
- MP RVU
- 0.13
- Office payment
- $170.68
- Facility payment
- $114.57
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 90865 in a non-facility setting with national GPCI: (2.84 + 2.14 + 0.13) × $33.4009 ≈ $170.68. The same code in a facility setting pays about $114.57 because facility PE RVU (0.46) replaces office PE RVU.
What changes by locality
GPCI moves 90865 non-facility payment from $158.49 to $220.8 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 90865?
2.84. 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 90865 in 2026?
About $170.68 non-facility ($114.57 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 (2.84) and malpractice RVU stay fixed; only practice expense changes (2.14 office vs 0.46 facility). That is the entire office-vs-facility payment gap.