CPT / HCPCS code · 2026 CMS data · Verified 2026-08-31
CPT 95972 RVU and Medicare Payment (2026)
Alys cplx sp/pn npgt w/prgrm — 0.8 work RVU, about $59.79 non-facility Medicare payment at the 2026 conversion factor.
- Work RVU
- 0.8
- PE RVU (non-facility)
- 0.92
- PE RVU (facility)
- 0.18
- MP RVU
- 0.07
- Office payment
- $59.79
- Facility payment
- $35.07
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 95972 in a non-facility setting with national GPCI: (0.8 + 0.92 + 0.07) × $33.4009 ≈ $59.79. The same code in a facility setting pays about $35.07 because facility PE RVU (0.18) replaces office PE RVU.
What changes by locality
GPCI moves 95972 non-facility payment from $54.32 to $75.22 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 95972?
0.8. 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 95972 in 2026?
About $59.79 non-facility ($35.07 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 (0.8) and malpractice RVU stay fixed; only practice expense changes (0.92 office vs 0.18 facility). That is the entire office-vs-facility payment gap.