CPT / HCPCS code · 2026 CMS data · Verified 2026-08-31
CPT 99204 RVU and Medicare Payment (2026)
Office o/p new mod 45 min — 2.6 work RVU, about $177.36 non-facility Medicare payment at the 2026 conversion factor.
- Work RVU
- 2.6
- PE RVU (non-facility)
- 2.47
- PE RVU (facility)
- 0.66
- MP RVU
- 0.24
- Office payment
- $177.36
- Facility payment
- $116.9
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 99204 in a non-facility setting with national GPCI: (2.6 + 2.47 + 0.24) × $33.4009 ≈ $177.36. The same code in a facility setting pays about $116.9 because facility PE RVU (0.66) replaces office PE RVU.
What changes by locality
GPCI moves 99204 non-facility payment from $161.84 to $222.54 across CMS localities — from Arkansas to Alaska. Check your exact locality in the GPCI calculator rather than using a state average.
Related codes
Going deeper: in-depth CPT 99204 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 99204?
2.6. 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 99204 in 2026?
About $177.36 non-facility ($116.9 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 (2.6) and malpractice RVU stay fixed; only practice expense changes (2.47 office vs 0.66 facility). That is the entire office-vs-facility payment gap.