CPT / HCPCS code · 2026 CMS data · Verified 2026-08-31
CPT 99281 RVU and Medicare Payment (2026)
Emr dpt vst mayx req phy/qhp — 0.25 work RVU, about $11.02 non-facility Medicare payment at the 2026 conversion factor.
- Work RVU
- 0.25
- PE RVU (non-facility)
- 0.05
- PE RVU (facility)
- 0.05
- MP RVU
- 0.03
- Office payment
- $11.02
- Facility payment
- $11.02
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 99281 in a non-facility setting with national GPCI: (0.25 + 0.05 + 0.03) × $33.4009 ≈ $11.02. The same code in a facility setting pays about $11.02 because facility PE RVU (0.05) replaces office PE RVU.
What changes by locality
GPCI moves 99281 non-facility payment from $10.26 to $14.86 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 99281?
0.25. 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 99281 in 2026?
About $11.02 non-facility ($11.02 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 (0.25) and malpractice RVU stay fixed; only practice expense changes (0.05 office vs 0.05 facility). That is the entire office-vs-facility payment gap.