CPT / HCPCS code · 2026 CMS data · Verified 2026-08-31
CPT 99305 RVU and Medicare Payment (2026)
1st nf care moderate mdm 35 — 2.5 work RVU, about $140.95 non-facility Medicare payment at the 2026 conversion factor.
- Work RVU
- 2.5
- PE RVU (non-facility)
- 1.54
- PE RVU (facility)
- 0.91
- MP RVU
- 0.18
- Office payment
- $140.95
- Facility payment
- $119.91
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 99305 in a non-facility setting with national GPCI: (2.5 + 1.54 + 0.18) × $33.4009 ≈ $140.95. The same code in a facility setting pays about $119.91 because facility PE RVU (0.91) replaces office PE RVU.
What changes by locality
GPCI moves 99305 non-facility payment from $130.78 to $183.35 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 99305?
2.5. 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 99305 in 2026?
About $140.95 non-facility ($119.91 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 (2.5) and malpractice RVU stay fixed; only practice expense changes (1.54 office vs 0.91 facility). That is the entire office-vs-facility payment gap.