CPT / HCPCS code · 2026 CMS data · Verified 2026-08-31
CPT 99495 RVU and Medicare Payment (2026)
Transj care mgmt mod f2f 14d — 2.78 work RVU, about $220.11 non-facility Medicare payment at the 2026 conversion factor.
- Work RVU
- 2.78
- PE RVU (non-facility)
- 3.62
- PE RVU (facility)
- 0.69
- MP RVU
- 0.19
- Office payment
- $220.11
- Facility payment
- $122.25
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 99495 in a non-facility setting with national GPCI: (2.78 + 3.62 + 0.19) × $33.4009 ≈ $220.11. The same code in a facility setting pays about $122.25 because facility PE RVU (0.69) replaces office PE RVU.
What changes by locality
GPCI moves 99495 non-facility payment from $199.99 to $280.82 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 99495?
2.78. 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 99495 in 2026?
About $220.11 non-facility ($122.25 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 (2.78) and malpractice RVU stay fixed; only practice expense changes (3.62 office vs 0.69 facility). That is the entire office-vs-facility payment gap.