CPT / HCPCS code · 2026 CMS data · Verified 2026-08-31
CPT 98972 RVU and Medicare Payment (2026)
Nqhp ol dig assmt&mgmt 21+ — 0.69 work RVU, about $34.4 non-facility Medicare payment at the 2026 conversion factor.
- Work RVU
- 0.69
- PE RVU (non-facility)
- 0.31
- PE RVU (facility)
- 0.15
- MP RVU
- 0.03
- Office payment
- $34.4
- Facility payment
- $29.06
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 98972 in a non-facility setting with national GPCI: (0.69 + 0.31 + 0.03) × $33.4009 ≈ $34.4. The same code in a facility setting pays about $29.06 because facility PE RVU (0.15) replaces office PE RVU.
What changes by locality
GPCI moves 98972 non-facility payment from $32.46 to $46.15 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 98972?
0.69. 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 98972 in 2026?
About $34.4 non-facility ($29.06 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 (0.69) and malpractice RVU stay fixed; only practice expense changes (0.31 office vs 0.15 facility). That is the entire office-vs-facility payment gap.