CPT 99213 and 99214 are adjacent established patient office or outpatient visit codes. In the imported 2026 CMS RVU dataset, 99214 carries higher work RVU, practice expense RVU, malpractice RVU, total RVU, and national Medicare payment than 99213. That difference is important for RVU modeling, productivity analysis, and contract review, but it is not a coding instruction. The appropriate E/M level must be supported by the applicable CPT, payer, documentation, medical decision making, or time rules before the RVU comparison is used.
Start with what the 2026 RVU data says
The 2026 imported RVU file describes 99213 as a low-complexity established office or outpatient visit with a 20-minute reference descriptor and 99214 as a moderate-complexity established office or outpatient visit with a 30-minute reference descriptor. For RVU modeling, the first distinction is numeric: 99213 has 1.30 work RVU, 1.46 non-facility PE RVU, 0.33 facility PE RVU, and 0.09 malpractice RVU. 99214 has 1.92 work RVU, 2.00 non-facility PE RVU, 0.47 facility PE RVU, and 0.14 malpractice RVU. Those inputs should be read as payment and productivity data after code selection, not as a shortcut for choosing an E/M level.
- 99213: 1.30 work RVU, 1.46 non-facility PE RVU, 0.33 facility PE RVU, 0.09 MP RVU.
- 99214: 1.92 work RVU, 2.00 non-facility PE RVU, 0.47 facility PE RVU, 0.14 MP RVU.
- The work RVU spread is 0.62 before any contract-specific compensation formula is applied.
2026 CMS RVU component comparison
The imported CMS file separates work, practice expense, and malpractice RVU. Compare the components before translating the result into payment or productivity.
Values are from the imported 2026 CMS RVU data used by RVUinUSA. The table is financial context, not an E/M code selection rule.
Read CPT RVU values as payment inputs
CPT-level RVU values explain payment and productivity impact after code selection. They do not replace documentation, payer policy, or coding review.
- Code selection
- Separate review
- Setting
- Facility or office
- Local estimate
- Apply GPCI
Compare total RVU in the same setting
A clean comparison keeps the site of service fixed. In the non-facility setting, national total RVU is 2.85 for 99213 and 4.06 for 99214 before the conversion factor is applied. In the facility setting, national total RVU is 1.72 for 99213 and 2.53 for 99214. The work RVU difference is the same across settings, but the practice expense component changes because CMS assigns different practice expense values to office and facility environments. Mixing office 99213 with facility 99214 would produce a distorted comparison.
- National non-facility total RVU: 2.85 for 99213 versus 4.06 for 99214.
- National facility total RVU: 1.72 for 99213 versus 2.53 for 99214.
- Use the same setting for both codes before interpreting the RVU spread.
Same-setting comparison rule
Use non-facility PE for both codes or facility PE for both codes. Do not mix settings inside a code-level comparison.
Translate the RVU spread into 2026 national payment
Using national GPCI values and the 2026 non-QPP conversion factor of $33.4009, the non-facility Medicare estimate is about $95.19 for 99213 and $135.61 for 99214. In the facility setting, the same assumptions produce about $57.45 for 99213 and $84.50 for 99214. QPP/APM status changes the final multiplier, not the underlying CPT RVU values. For a professional comparison, document the year, setting, GPCI locality, and conversion factor status alongside the final payment estimate.
- National non-QPP non-facility estimate: about $95.19 for 99213 and $135.61 for 99214.
- National non-QPP facility estimate: about $57.45 for 99213 and $84.50 for 99214.
- QPP/APM comparison should change only the conversion factor, not the code, setting, or locality.
National non-QPP payment estimate
These estimates use national GPCI assumptions and the 2026 non-QPP conversion factor. Locality-specific estimates should be recalculated with the same locality applied to both codes.
Payment estimates are rounded for article readability. Calculator output should be used for scenario-specific comparisons.
Keep coding judgment separate from RVU interpretation
The RVU difference is financially meaningful, which is exactly why the coding boundary must be explicit. A higher RVU does not make 99214 appropriate. E/M level selection depends on the rules that apply to the encounter, including documentation, medical decision making, time when applicable, payer policy, modifiers, and compliance review. RVUinUSA should be used after the code is supported, so the user can understand the payment or productivity effect of a legitimate code-level difference.
- Do not select 99214 because it has a higher RVU value.
- Use the applicable E/M documentation and payer rules to support the level.
- Use RVU output to quantify impact after the coding basis is established.
Model productivity impact with legitimate volume only
For physician compensation, the most visible difference is the 0.62 work RVU spread between the two codes. Across a large panel of established patient visits, that spread can materially affect annual credited wRVU. The calculation still depends on legitimate code distribution and the written compensation plan. Some plans use the current CMS RVU schedule, some freeze a prior year, and some exclude modifiers, supervision services, or certain payer categories from productivity credit. A contract review should therefore model the RVU difference only after confirming how the employer credits E/M services.
- The 0.62 wRVU spread matters only for encounters correctly supported at each level.
- Annual compensation impact depends on visit volume and the dollars-per-wRVU rate.
- The contract should define the RVU schedule year, exclusions, modifiers, and crediting method.
Use locality adjustment only after the base comparison is clean
GPCI adjustment can change the payment estimate for each code, but it should not be introduced until the base comparison is clean. First compare 99213 and 99214 with the same setting and national assumptions. Then apply the same locality to both codes. Work GPCI adjusts work RVU, PE GPCI adjusts the selected practice expense RVU, and MP GPCI adjusts malpractice RVU. If the locality changes for one code but not the other, the result is no longer a 99213-versus-99214 comparison; it is a mixed code and geography scenario.
- Apply the same locality to both codes when comparing payment.
- Remember that PE GPCI can matter more in office-based comparisons because PE RVU is larger outside the facility setting.
- Use locality pages for market-specific payment estimates after the national comparison is understood.
How to use this comparison in RVUinUSA
The practical workflow is to open the individual CPT pages for 99213 and 99214, confirm the imported 2026 RVU components, and then run the calculator with the same setting, GPCI locality, and participant status for both codes. If the question is compensation, move from the code comparison into the salary estimator or contract analyzer and apply the employment agreement's wRVU rules. If the question is billing or compliance, use the RVU output as financial context only and route code selection through the proper documentation and payer review process.
- Use /cpt/99213 and /cpt/99214 to verify code-level RVU inputs.
- Use the RVU calculator for same-assumption payment comparison.
- Use contract tools only after the code mix and RVU crediting rules are known.
Run the comparison with your assumptions
Use these RVUinUSA workflows after confirming the code level is supported.