CPT / HCPCS code · 2026 CMS data · Verified 2026-08-31
CPT 99425 RVU and Medicare Payment (2026)
Prin care mgmt phys ea addl — 1 work RVU, about $61.46 non-facility Medicare payment at the 2026 conversion factor.
- Work RVU
- 1
- PE RVU (non-facility)
- 0.77
- PE RVU (facility)
- 0.25
- MP RVU
- 0.07
- Office payment
- $61.46
- Facility payment
- $44.09
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 99425 in a non-facility setting with national GPCI: (1 + 0.77 + 0.07) × $33.4009 ≈ $61.46. The same code in a facility setting pays about $44.09 because facility PE RVU (0.25) replaces office PE RVU.
What changes by locality
GPCI moves 99425 non-facility payment from $56.7 to $78.78 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 99425?
1. 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 99425 in 2026?
About $61.46 non-facility ($44.09 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) and malpractice RVU stay fixed; only practice expense changes (0.77 office vs 0.25 facility). That is the entire office-vs-facility payment gap.