CPT / HCPCS code · 2026 CMS data · Verified 2026-08-31
CPT 97597 RVU and Medicare Payment (2026)
Dbrdmt opn wnd 1st 20 cm/ — 0.75 work RVU, about $101.54 non-facility Medicare payment at the 2026 conversion factor.
- Work RVU
- 0.75
- PE RVU (non-facility)
- 2.24
- PE RVU (facility)
- 0.13
- MP RVU
- 0.05
- Office payment
- $101.54
- Facility payment
- $31.06
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 97597 in a non-facility setting with national GPCI: (0.75 + 2.24 + 0.05) × $33.4009 ≈ $101.54. The same code in a facility setting pays about $31.06 because facility PE RVU (0.13) replaces office PE RVU.
What changes by locality
GPCI moves 97597 non-facility payment from $90.18 to $136.59 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 97597?
0.75. 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 97597 in 2026?
About $101.54 non-facility ($31.06 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 (0.75) and malpractice RVU stay fixed; only practice expense changes (2.24 office vs 0.13 facility). That is the entire office-vs-facility payment gap.