CPT / HCPCS code · 2026 CMS data · Verified 2026-08-31
CPT 99203 RVU and Medicare Payment (2026)
Office o/p new low 30 min — 1.6 work RVU, about $117.57 non-facility Medicare payment at the 2026 conversion factor.
- Work RVU
- 1.6
- PE RVU (non-facility)
- 1.76
- PE RVU (facility)
- 0.38
- MP RVU
- 0.16
- Office payment
- $117.57
- Facility payment
- $71.48
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 99203 in a non-facility setting with national GPCI: (1.6 + 1.76 + 0.16) × $33.4009 ≈ $117.57. The same code in a facility setting pays about $71.48 because facility PE RVU (0.38) replaces office PE RVU.
What changes by locality
GPCI moves 99203 non-facility payment from $106.69 to $146.95 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
Going deeper: in-depth CPT 99203 RVU guide.
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 99203?
1.6. 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 99203 in 2026?
About $117.57 non-facility ($71.48 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 (1.6) and malpractice RVU stay fixed; only practice expense changes (1.76 office vs 0.38 facility). That is the entire office-vs-facility payment gap.