Participating physician · Before sequestration
CMS evidence · Q1 2026 release
( Work7.12 × 1.000 + Practice exp.48.81 × 1.000 + Malpractice0.88 × 1.000 ) × Conv. factor$33.4009 = $1,897.51
F Work RVU
7.12
G Non‑facility PE RVU
48.81
K MP RVU
0.88
Z Conversion factor
33.4009
( Work7.12 × 1.000 + Practice exp.1.13 × 1.000 + Malpractice0.88 × 1.000 ) × Conv. factor$33.4009 = $304.95
F Work RVU
7.12
I Facility PE RVU
1.13
K MP RVU
0.88
Z Conversion factor
33.4009
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Physician relative value file (PPRRVU) · PPRRVU2026_Jan_nonQPP.csv row 4,361 in rvu26a-updated-12-29-2025.zip Download from CMS
Loading rows 4,359–4,363 of PPRRVU2026_Jan_nonQPP.csv…
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Physician relative value file (PPRRVU) · PPRRVU2026_Jan_nonQPP.csv row 4,361 in rvu26a-updated-12-29-2025.zip Download from CMS
Loading rows 4,359–4,363 of PPRRVU2026_Jan_nonQPP.csv…
Nationally priced under PFS, using the RVU formula.
CMS RVU26AJanuary 1 – March 31, 2026
The national PFS baseline was $1,897.51 for CPT 36253 in the Office (non-facility) setting and $304.95 in a facility under the Q1 2026 Physician Fee Schedule, effective January 2026. These are the national allowed amounts before locality (GPCI) adjustment; sequestration is excluded.
Why are the facility and non-facility amounts different?
Only the practice-expense RVU changes with the setting. For 36253 it's 48.81 RVUs in the Office (non-facility) setting versus 1.13 in a facility—the whole $1,592.56 gap between $1,897.51 and $304.95. In the Office (non-facility) setting the practice bears the overhead, so the allowed amount is higher; in a hospital or ASC the facility bills its own fee, so the professional amount is lower. See facility vs non-facility.
Sources: CMS Medicare Physician Fee Schedule Relative Value Files; CMS Practice Expense methodology (cms.gov).
Contract rate as % of Medicare Copy link
Applies to your locality's allowed amount, not the $1,897.51 national baseline. How to find your contract's percentage.
Need rates from another insurer? Join the waitlist →
Allowed amount, Medicare's share, and patient share Copy link
A physician's $1,897.51 Office (non-facility) allowed amount: Medicare pays $1,487.65 after sequestration and the patient owes $379.50, once the Part B deductible is met.
| Billed by | Allowed amount | Participating claim | If not participating | ||
|---|---|---|---|---|---|
| What Medicare pays | Patient coinsurance | Non-participating amount | Limiting charge | ||
| Physician (MD/DO) 100% Calculator | $1,897.51 | $1,487.65 $1,518.01 − $30.36 | $379.50 | $1,802.63 | $2,073.02 |
| Physician assisting at surgery (-80, -81, -82) Calculator | Not payable | ||||
National Q1 2026, GPCI 1.000. Rows are provider types with at least 1% of 36253’s Medicare services in CMS’s CY2024 Physician & Other Practitioners data; each % applies before the 80/20 split and sequestration.
Is $1,897.51 what a practice actually receives?
It's the national allowed amount—the starting point. Medicare pays 80% of it ($1,518.01) and the patient owes 20% coinsurance ($379.50). Sequestration trims Medicare's share by about 2%, your locality's GPCIs scale the total up or down, and the expected-payment calculator applies all three. That payment is practice revenue that covers staff, space, equipment, and billing. It isn't the clinician's take-home pay. The practice-expense RVU above is CMS's estimate of that overhead share.
Sources: Budget Control Act sequestration provisions; CMS Medicare Fee-for-Service payment guidance; CMS Geographic Practice Cost Index (GPCI) files; CMS Physician Fee Schedule overview (cms.gov).
What's the non-participating amount for 36253?
$1,802.63 in the Office (non-facility) setting—95% of the $1,897.51 participating fee schedule amount above. A participating provider takes the fee schedule amount as payment in full on every claim. A non-participating provider is paid this reduced amount, but chooses claim by claim whether to accept assignment. See participating vs non-participating.
Sources: CMS Physician Fee Schedule overview (cms.gov); CMS Medicare Fee-for-Service payment guidance.
What's the limiting charge for 36253?
$2,073.02 in the Office (non-facility) setting—the ceiling on what a non-participating provider can bill the patient on an unassigned claim. That's 109.25% of the $1,897.51 amount above. The non-participating amount is 95% of the fee schedule rate ($1,802.63), and the statutory cap is 115% of that. See limiting charge.
Sources: CMS Physician Fee Schedule overview (cms.gov); CMS Medicare Fee-for-Service payment guidance.
CMS RVU26AJanuary 1 – March 31, 2026 See file rows
Which billing rules and modifiers apply? Copy link
CMS indicators that apply to 36253: GLOB DAYS 000 (same day only) · MULT PROC 2 (standard reduction applies).
Same day only
GLOB DAYS
000
The fee covers pre-operative and post-operative work on the day of the procedure only—there is no follow-up window afterward. A visit the next day is separately payable.
Standard reduction applies
MULT PROC
2
When billed with other procedures on the same date, the highest-valued one is paid at 100% and the next four at 50% each.
-51 depends on the other codes on the same claim, so it's a claim-level number rather than a per-code one.
Not payable with 36253: -26/TC · -50 · -80/81/82 · -AS · -62 · -66.
Why would a Medicare claim for 36253 be denied or paid less?
These come from CMS indicators on this page, not general billing advice.
- Bilateral surgery: no bilateral adjustment. See billing policy
- Assistant at surgery: never separately payable. See billing policy
- Co-surgeons: not permitted. See billing policy
- Team surgery: not permitted. See billing policy
- Multiple procedures: standard reduction applies. See billing policy
Payer-specific coverage and documentation rules live outside these files, so a claim that clears every check here can still be denied on other grounds.
CMS RVU26AJanuary 1 – March 31, 2026 See file rows
Can you bill it with another code? Copy link
Payment review for 36253 Copy link
What to check (5)
Four published payment rules can change what 36253 allows on a claim: the office/facility differential, the same-day global package, the standard multiple-procedure reduction and the assistant-at-surgery prohibition. Each is a legitimate reason for a paid amount to differ from the fee-schedule amount on this page.
- Check the place-of-service code before attributing the gap to the payer: office and facility pricing differ by $1,592.56 nationally at GPCI 1.000, before any locality adjustment.
- Check the visit date: this code carries no follow-up window, so a related visit the day after the procedure is separately payable and should not have bundled.
- Rank the claim’s procedure lines before calling this one short-paid: billed with a higher-valued procedure on the same date, its allowed amount is $948.76 instead of $1,897.51 (national, GPCI 1.000). That is the rule, not a payer error.
- Expect an assistant-at-surgery denial here rather than appealing it—a -80 or -AS line on this procedure is never separately payable.
- Reprice the line against the release, locality, setting, modifier and participation status that applied to the date of service before treating any difference as an underpayment.
Sources: CMS Medicare Physician Fee Schedule Relative Value Files; CMS Practice Expense methodology (cms.gov); CMS Medicare Claims Processing Manual (Pub. 100-04); 42 USC 1395w-4(i)(2) (SSA §1848(i)(2))—Assistants-at-surgery.
How location and RVUs set the amount Copy link
Office (non-facility): 56.81 RVUs × $33.4009 = $1,897.51 national PFS baseline. Local GPCIs move it from $1,653.38 in Arkansas, AR to $2,630.62 in San Jose-Sunnyvale-Santa Clara (San Benito County), CA.
Office (non-facility)
| Component | RVU | × GPCI | = |
|---|---|---|---|
| Work | 7.12 | 1.000 | 7.12 |
| Practice expense | 48.81 | 1.000 | 48.81 |
| Malpractice | 0.88 | 1.000 | 0.88 |
| Total RVUs | 56.81 | ||
| × Conversion factor | $33.4009 | ||
| = National PFS baseline | $1,897.51 | ||
Facility
| Component | RVU | × GPCI | = |
|---|---|---|---|
| Work | 7.12 | 1.000 | 7.12 |
| Practice expense | 1.13 | 1.000 | 1.13 |
| Malpractice | 0.88 | 1.000 | 0.88 |
| Total RVUs | 9.13 | ||
| × Conversion factor | $33.4009 | ||
| = National PFS baseline | $304.95 | ||
Rates by locality Copy link
36253 Office (non-facility) by metro, highest first
Show 56 more metros Show fewer metros
36253 Facility by metro, highest first
Show 56 more metros Show fewer metros
Q1 2026, each locality's GPCIs, before sequestration. Multi-locality states are shaded by their mean. Look up your exact locality →
CMS RVU26AJanuary 1 – March 31, 2026 See file rows
Source & method Copy link
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01 PPRRVU2026_Jan_nonQPP.csv · Q1 2026 (RVU26A) · row 4,361—status A, RVUs limits
- Effective
- January 1 – March 31, 2026
- Locator
- PPRRVU2026_Jan_nonQPP.csv in rvu26a-updated-12-29-2025.zip · row 4,361 of 19,226 · via CMS
- Fields read
-
Status A (col 4) Work RVU 7.12 (col 6) Office (non-facility) PE RVU 48.81 (col 7) Facility PE RVU 1.13 (col 9) Malpractice RVU 0.88 (col 11)SHA-256 9a15cb9cc117f079…
- Doesn’t establish
- A locality-adjusted allowed amount, or the payment after sequestration. National baselines use GPCI 1.000 and exclude sequestration.
- Note
- Whether a national amount exists depends on the status and CMS’s payment instructions; blank RVUs are never treated as zero.
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02 Conversion factor · same file · row 4,361 · column 26—$33.4009
- Source
- Conversion factor, read from the same file as the RVUs
-
03 Physician & Other Practitioners · CY2024—volume and who bills it limits
- Effective
- Calendar-year snapshot, on a different cycle from the Q1 2026 fee schedule
- Doesn’t establish
- Medicare Advantage, Medicaid or commercial volume.
- Note
- The dataset suppresses rows under 11 beneficiaries.
Cite this rate
CPT 36253 National PFS baseline: Office (non-facility) $1,897.51; Facility $304.95 (Q1 2026; participating physician; whole service; GPCI 1.000; sequestration excluded). CMS RVU26A, PPRRVU2026_Jan_nonQPP.csv row 4,361. Localis. https://localishealth.com/cpt/36253/2026/A
Past releases are never edited, so the citation stays checkable after CMS publishes a newer one. Methodology · Plain-text summary · JSON
How has it changed? Copy link
$1,897.51 Office (non-facility) and $304.95 Facility since Jan 1, 2026, after a +2.1% increase in the Office (non-facility) amount. -18.2% decrease since Q1 2013; peak $2,319.01 in Q1 2013.
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Jan 1, 2026 – present
Q1 2026
Still in effect · 4 releases at this rate- Office
- $1,897.51 (+$39.20, +2.1% increase)
- Facility
- $304.95 (−$29.84, -8.9% decrease)
Q1 2026 Jan 1, 2026 – Mar 31, 2026 · Q2 2026 Apr 1, 2026 – Jun 30, 2026 · Q3 2026 Jul 1, 2026 – Sep 30, 2026 · Q4 2026 Oct 1, 2026 – present
- +$60.58 the conversion factor
- −$16.37 practice-expense RVUs
- −$6.01 work RVUs
- +$1.00 malpractice RVUs
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Jan 1, 2025 – Dec 31, 2025
Q1 2025
4 releases at this rate- Office
- $1,858.31 (−$106.32, -5.4% decrease)
- Facility
- $334.79 (−$7.74, -2.3% decrease)
Q1 2025 Jan 1, 2025 – Mar 31, 2025 · Q2 2025 Apr 1, 2025 – Jun 30, 2025 · Q3 2025 Jul 1, 2025 – Sep 30, 2025 · Q4 2025 Oct 1, 2025 – Dec 31, 2025
- −$55.54 the conversion factor
- −$49.81 practice-expense RVUs
- −$0.97 malpractice RVUs
-
Mar 9, 2024 – Dec 31, 2024
Q1 2024
4 releases at this rate- Office
- $1,964.63 (+$32.07, +1.7% increase)
- Facility
- $342.53 (+$5.59, +1.7% increase)
Q1 2024 Mar 9, 2024 – Mar 31, 2024 · Q2 2024 Apr 1, 2024 – Jun 30, 2024 · Q3 2024 Jul 1, 2024 – Sep 30, 2024 · Q4 2024 Oct 1, 2024 – Dec 31, 2024
- +$32.07 the conversion factor
-
Jan 1, 2024 – Mar 8, 2024 · Superseded revision
Q1 2024 rev 1
Revision 1, later corrected by CMS- Office
- $1,932.56
- Facility
- $336.94
-
Jan 1, 2023 – Dec 31, 2023
Q1 2023
4 releases at this rate- Office
- $2,054.24 (−$102.07, -4.7% decrease)
- Facility
- $348.70 (−$7.74, -2.2% decrease)
Q1 2023 Jan 1, 2023 – Mar 31, 2023 · Q2 2023 Apr 1, 2023 – Jun 30, 2023 · Q3 2023 Jul 1, 2023 – Sep 30, 2023 · Q4 2023 Oct 1, 2023 – Dec 31, 2023
- −$57.61 practice-expense RVUs
- −$44.80 the conversion factor
- +$0.34 malpractice RVUs
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Jan 1, 2022 – Dec 31, 2022
Q1 2022
4 releases at this rate- Office
- $2,156.31 (−$120.81, -5.3% decrease)
- Facility
- $356.44 (−$1.56, -0.4% decrease)
Q1 2022 Jan 1, 2022 – Mar 31, 2022 · Q2 2022 Apr 1, 2022 – Jun 30, 2022 · Q3 2022 Jul 1, 2022 – Sep 30, 2022 · Q4 2022 Oct 1, 2022 – Dec 31, 2022
- −$103.47 practice-expense RVUs
- −$18.72 the conversion factor
- +$1.38 malpractice RVUs
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Jan 1, 2021 – Dec 31, 2021
Q1 2021
4 releases at this rate- Office
- $2,277.12 (+$4.92, +0.2% increase)
- Facility
- $358.00 (−$15.53, -4.2% decrease)
Q1 2021 Jan 1, 2021 – Mar 31, 2021 · Q2 2021 Apr 1, 2021 – Jun 30, 2021 · Q3 2021 Jul 1, 2021 – Sep 30, 2021 · Q4 2021 Oct 1, 2021 – Dec 31, 2021
- +$79.55 practice-expense RVUs
- −$75.33 the conversion factor
- +$0.70 malpractice RVUs
-
Jan 1, 2020 – Dec 31, 2020
Q1 2020
4 releases at this rate- Office
- $2,272.20 (+$16.15, +0.7% increase)
- Facility
- $373.53 (−$0.20, -0.1% decrease)
Q1 2020 Jan 1, 2020 – Mar 31, 2020 · Q2 2020 Apr 1, 2020 – Jun 30, 2020 · Q3 2020 Jul 1, 2020 – Sep 30, 2020 · Q4 2020 Oct 1, 2020 – Dec 31, 2020
- +$12.99 practice-expense RVUs
- +$3.16 the conversion factor
-
Jan 1, 2019 – Dec 31, 2019
Q1 2019
4 releases at this rate- Office
- $2,256.05 (+$1.04, 0.0% no change)
- Facility
- $373.73 (−$1.75, -0.5% decrease)
Q1 2019 Jan 1, 2019 – Mar 31, 2019 · Q2 2019 Apr 1, 2019 – Jun 30, 2019 · Q3 2019 Jul 1, 2019 – Sep 30, 2019 · Q4 2019 Oct 1, 2019 – Dec 31, 2019
- +$2.48 the conversion factor
- −$0.72 practice-expense RVUs
- −$0.72 malpractice RVUs
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Jan 1, 2018 – Dec 31, 2018
Q1 2018
4 releases at this rate- Office
- $2,255.01 (+$13.76, +0.6% increase)
- Facility
- $375.48 (−$3.15, -0.8% decrease)
Q1 2018 Jan 1, 2018 – Mar 31, 2018 · Q2 2018 Apr 1, 2018 – Jun 30, 2018 · Q3 2018 Jul 1, 2018 – Sep 30, 2018 · Q4 2018 Oct 1, 2018 – Dec 31, 2018
- +$8.27 practice-expense RVUs
- +$6.93 the conversion factor
- −$1.44 malpractice RVUs
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Jan 1, 2017 – Dec 31, 2017
Q1 2017
4 releases at this rate- Office
- $2,241.25 (−$72.07, -3.1% decrease)
- Facility
- $378.63 (−$15.58, -4.0% decrease)
Q1 2017 Jan 1, 2017 – Mar 31, 2017 · Q2 2017 Apr 1, 2017 – Jun 30, 2017 · Q3 2017 Jul 1, 2017 – Sep 30, 2017 · Q4 2017 Oct 1, 2017 – Dec 31, 2017
- −$65.32 practice-expense RVUs
- −$8.97 work RVUs
- +$5.45 the conversion factor
- −$3.23 malpractice RVUs
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Jan 1, 2016 – Dec 31, 2016
Q1 2016
4 releases at this rate- Office
- $2,313.32 (−$4.39, -0.2% decrease)
- Facility
- $394.21 (−$2.14, -0.5% decrease)
Q1 2016 Jan 1, 2016 – Mar 31, 2016 · Q2 2016 Apr 1, 2016 – Jun 30, 2016 · Q3 2016 Jul 1, 2016 – Sep 30, 2016 · Q4 2016 Oct 1, 2016 – Dec 31, 2016
- −$8.33 the conversion factor
- +$5.73 practice-expense RVUs
- −$1.79 malpractice RVUs
-
Oct 1, 2015 – Dec 31, 2015
- Office
- $2,317.71 (+$11.53, +0.5% increase)
- Facility
- $396.35 (+$1.98, +0.5% increase)
- +$11.53 the conversion factor
-
Jan 1, 2015 – Sep 30, 2015
Q1 2015
3 releases at this rate- Office
- $2,306.18 (−$0.81, 0.0% no change)
- Facility
- $394.37 (−$15.08, -3.7% decrease)
Q1 2015 Jan 1, 2015 – Mar 31, 2015 · Q2 2015 Apr 1, 2015 – Jun 30, 2015 · Q3 2015 Jul 1, 2015 – Sep 30, 2015
- +$16.45 practice-expense RVUs
- −$12.87 malpractice RVUs
- −$4.39 the conversion factor
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Apr 1, 2014 – Dec 31, 2014
Q2 2014
3 releases at this rate- Office
- $2,306.99 (−$12.02, -0.5% decrease)
- Facility
- $409.45 (+$17.85, +4.6% increase)
Q2 2014 Apr 1, 2014 – Jun 30, 2014 · Q3 2014 Jul 1, 2014 – Sep 30, 2014 · Q4 2014 Oct 1, 2014 – Dec 31, 2014
- −$132.54 practice-expense RVUs
- +$122.67 the conversion factor
- −$2.15 malpractice RVUs
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Jan 1, 2013 – Jun 30, 2013
Q1 2013
2 releases at this rate- Office
- $2,319.01
- Facility
- $391.60
Q1 2013 Jan 1, 2013 – Mar 31, 2013 · Q2 2013 Apr 1, 2013 – Jun 30, 2013
Earliest release in this history.
National baseline (GPCI 1.000), before sequestration.
How each change is split
When does this rate change?
CMS publishes a fee schedule release every quarter (January, April, July, October), and each is versioned here. See what changed each release, or get an email when a new release moves rates.
The 36253 rate last moved in Q1 2026. See its rate history.
Sources: CMS Medicare Physician Fee Schedule Relative Value Files.
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Usage and related codes Copy link
In CY2024, 36253 ranked #3,843 of the 7,879 CPT codes billed to Medicare that year, by patients served or total allowed dollars.
- Services
- 1,810
- Allowed
- $422,720
- Beneficiaries
- 1,728
CY2024 Medicare fee-for-service, from the CMS Physician & Other Practitioners dataset (limits).