Guide · Updated Jul 6, 2026
Facility vs Non-Facility Rates
Medicare pays a different amount for the same code depending on where the service is performed. The non-facility rate applies in settings like a physician’s office; the facility rate applies in settings like a hospital or ambulatory surgical center. The difference comes entirely from the practice expense RVU.
Why the two rates differ
In a non-facility setting, the practice pays for the space, staff, and supplies, so Medicare uses the higher non-facility practice expense RVU. In a facility setting, the hospital or ASC is paid separately for those resources, so Medicare uses the lower facility practice expense RVU. The work and malpractice RVUs are the same in both settings — only the practice expense component changes.
How to choose the right one
Pick the setting that matches where the service is actually delivered. Billing the office (non-facility) rate for a service performed in a hospital, or vice versa, produces the wrong amount. Every rate lookup on our code pages shows both so you can compare them directly — see CPT 99213 for an example.
When only one applies
Some services are only ever performed in one type of setting, so one of the two figures may be absent or identical. When a practice expense RVU is blank for a setting, that setting has no separately calculated amount — a blank is not a zero.
Frequently asked
Which rate is higher?
The non-facility (office) rate is usually higher, because the practice absorbs the overhead that a hospital or ASC would otherwise be paid for separately.
Does the work RVU change between settings?
No. Only the practice expense RVU differs between facility and non-facility. Work and malpractice RVUs are the same.
Related
Sources
Written from primary CMS sources — see how we source, compute, and verify everything on this site.