CPT / HCPCS code · 2026 CMS data · Verified 2026-08-31
CPT 21616 RVU and Medicare Payment (2026)
Exc 1st&/crv rib w/sympth — 12.37 work RVU, about $666.01 non-facility Medicare payment at the 2026 conversion factor.
- Work RVU
- 12.37
- PE RVU (non-facility)
- 4.41
- PE RVU (facility)
- 4.41
- MP RVU
- 3.16
- Office payment
- $666.01
- Facility payment
- $666.01
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 21616 in a non-facility setting with national GPCI: (12.37 + 4.41 + 3.16) × $33.4009 ≈ $666.01. The same code in a facility setting pays about $666.01 because facility PE RVU (4.41) replaces office PE RVU.
What changes by locality
GPCI moves 21616 non-facility payment from $586.79 to $834.78 across CMS localities — from Wisconsin 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 21616?
12.37. 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 21616 in 2026?
About $666.01 non-facility ($666.01 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 (12.37) and malpractice RVU stay fixed; only practice expense changes (4.41 office vs 4.41 facility). That is the entire office-vs-facility payment gap.