CPT / HCPCS code · 2026 CMS data · Verified 2026-08-31
CPT 90959 RVU and Medicare Payment (2026)
Esrd serv 1 vst p mo 12-19 — 6.19 work RVU, about $339.02 non-facility Medicare payment at the 2026 conversion factor.
- Work RVU
- 6.19
- PE RVU (non-facility)
- 3.57
- PE RVU (facility)
- 3.57
- MP RVU
- 0.39
- Office payment
- $339.02
- Facility payment
- $339.02
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 90959 in a non-facility setting with national GPCI: (6.19 + 3.57 + 0.39) × $33.4009 ≈ $339.02. The same code in a facility setting pays about $339.02 because facility PE RVU (3.57) replaces office PE RVU.
What changes by locality
GPCI moves 90959 non-facility payment from $315.89 to $444.3 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 90959?
6.19. 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 90959 in 2026?
About $339.02 non-facility ($339.02 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 (6.19) and malpractice RVU stay fixed; only practice expense changes (3.57 office vs 3.57 facility). That is the entire office-vs-facility payment gap.