CPT / HCPCS code · 2026 CMS data · Verified 2026-08-31
CPT 99155 RVU and Medicare Payment (2026)
Mod sed oth phys/qhp — 1.9 work RVU, about $81.5 non-facility Medicare payment at the 2026 conversion factor.
- Work RVU
- 1.9
- PE RVU (non-facility)
- 0.3
- PE RVU (facility)
- 0.3
- MP RVU
- 0.24
- Office payment
- $81.5
- Facility payment
- $81.5
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 99155 in a non-facility setting with national GPCI: (1.9 + 0.3 + 0.24) × $33.4009 ≈ $81.5. The same code in a facility setting pays about $81.5 because facility PE RVU (0.3) replaces office PE RVU.
What changes by locality
GPCI moves 99155 non-facility payment from $75.53 to $110.28 across CMS localities — from Wisconsin 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 99155?
1.9. 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 99155 in 2026?
About $81.5 non-facility ($81.5 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 (1.9) and malpractice RVU stay fixed; only practice expense changes (0.3 office vs 0.3 facility). That is the entire office-vs-facility payment gap.