CPT / HCPCS code · 2026 CMS data · Verified 2026-08-31
CPT 99415 RVU and Medicare Payment (2026)
Prolng clin staff svc 1st hr — 0 work RVU, about $23.05 non-facility Medicare payment at the 2026 conversion factor.
- Work RVU
- 0
- PE RVU (non-facility)
- 0.68
- PE RVU (facility)
- 0.68
- MP RVU
- 0.01
- Office payment
- $23.05
- Facility payment
- $23.05
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 99415 in a non-facility setting with national GPCI: (0 + 0.68 + 0.01) × $33.4009 ≈ $23.05. The same code in a facility setting pays about $23.05 because facility PE RVU (0.68) replaces office PE RVU.
What changes by locality
GPCI moves 99415 non-facility payment from $19.68 to $32.93 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
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 99415?
0. 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 99415 in 2026?
About $23.05 non-facility ($23.05 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) and malpractice RVU stay fixed; only practice expense changes (0.68 office vs 0.68 facility). That is the entire office-vs-facility payment gap.