CPT / HCPCS code · 2026 CMS data · Verified 2026-08-31
CPT 90963 RVU and Medicare Payment (2026)
Esrd home pt serv p mo — 12.09 work RVU, about $626.27 non-facility Medicare payment at the 2026 conversion factor.
- Work RVU
- 12.09
- PE RVU (non-facility)
- 5.91
- PE RVU (facility)
- 5.91
- MP RVU
- 0.75
- Office payment
- $626.27
- Facility payment
- $626.27
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 90963 in a non-facility setting with national GPCI: (12.09 + 5.91 + 0.75) × $33.4009 ≈ $626.27. The same code in a facility setting pays about $626.27 because facility PE RVU (5.91) replaces office PE RVU.
What changes by locality
GPCI moves 90963 non-facility payment from $586.28 to $829.76 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 90963?
12.09. 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 90963 in 2026?
About $626.27 non-facility ($626.27 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 (12.09) and malpractice RVU stay fixed; only practice expense changes (5.91 office vs 5.91 facility). That is the entire office-vs-facility payment gap.