CPT / HCPCS code · 2026 CMS data · Verified 2026-08-31
CPT 99157 RVU and Medicare Payment (2026)
Mod sed other phys/qhp ea — 1.25 work RVU, about $54.11 non-facility Medicare payment at the 2026 conversion factor.
- Work RVU
- 1.25
- PE RVU (non-facility)
- 0.23
- PE RVU (facility)
- 0.23
- MP RVU
- 0.14
- Office payment
- $54.11
- Facility payment
- $54.11
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 99157 in a non-facility setting with national GPCI: (1.25 + 0.23 + 0.14) × $33.4009 ≈ $54.11. The same code in a facility setting pays about $54.11 because facility PE RVU (0.23) replaces office PE RVU.
What changes by locality
GPCI moves 99157 non-facility payment from $50.55 to $73.38 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 99157?
1.25. 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 99157 in 2026?
About $54.11 non-facility ($54.11 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 (1.25) and malpractice RVU stay fixed; only practice expense changes (0.23 office vs 0.23 facility). That is the entire office-vs-facility payment gap.