CPT / HCPCS code · 2026 CMS data · Verified 2026-08-31
CPT 99151 RVU and Medicare Payment (2026)
Mod sed same phys/qhp — 0.5 work RVU, about $62.13 non-facility Medicare payment at the 2026 conversion factor.
- Work RVU
- 0.5
- PE RVU (non-facility)
- 1.33
- PE RVU (facility)
- 0.1
- MP RVU
- 0.03
- Office payment
- $62.13
- Facility payment
- $21.04
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 99151 in a non-facility setting with national GPCI: (0.5 + 1.33 + 0.03) × $33.4009 ≈ $62.13. The same code in a facility setting pays about $21.04 because facility PE RVU (0.1) replaces office PE RVU.
What changes by locality
GPCI moves 99151 non-facility payment from $55.38 to $83.13 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 99151?
0.5. 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 99151 in 2026?
About $62.13 non-facility ($21.04 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 (0.5) and malpractice RVU stay fixed; only practice expense changes (1.33 office vs 0.1 facility). That is the entire office-vs-facility payment gap.