CPT / HCPCS code · 2026 CMS data · Verified 2026-08-31
CPT 99304 RVU and Medicare Payment (2026)
1st nf care sf/low mdm 25 — 1.5 work RVU, about $81.16 non-facility Medicare payment at the 2026 conversion factor.
- Work RVU
- 1.5
- PE RVU (non-facility)
- 0.84
- PE RVU (facility)
- 0.54
- MP RVU
- 0.09
- Office payment
- $81.16
- Facility payment
- $71.14
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 99304 in a non-facility setting with national GPCI: (1.5 + 0.84 + 0.09) × $33.4009 ≈ $81.16. The same code in a facility setting pays about $71.14 because facility PE RVU (0.54) replaces office PE RVU.
What changes by locality
GPCI moves 99304 non-facility payment from $75.75 to $106.69 across CMS localities — from Arkansas 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 99304?
1.5. 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 99304 in 2026?
About $81.16 non-facility ($71.14 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 (1.5) and malpractice RVU stay fixed; only practice expense changes (0.84 office vs 0.54 facility). That is the entire office-vs-facility payment gap.