CPT / HCPCS code · 2026 CMS data · Verified 2026-08-31
CPT 99423 RVU and Medicare Payment (2026)
Ol dig e/m svc 21+ min — 0.8 work RVU, about $48.77 non-facility Medicare payment at the 2026 conversion factor.
- Work RVU
- 0.8
- PE RVU (non-facility)
- 0.61
- PE RVU (facility)
- 0.2
- MP RVU
- 0.05
- Office payment
- $48.77
- Facility payment
- $35.07
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 99423 in a non-facility setting with national GPCI: (0.8 + 0.61 + 0.05) × $33.4009 ≈ $48.77. The same code in a facility setting pays about $35.07 because facility PE RVU (0.2) replaces office PE RVU.
What changes by locality
GPCI moves 99423 non-facility payment from $45.08 to $62.7 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 99423?
0.8. 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 99423 in 2026?
About $48.77 non-facility ($35.07 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 (0.8) and malpractice RVU stay fixed; only practice expense changes (0.61 office vs 0.2 facility). That is the entire office-vs-facility payment gap.