CPT / HCPCS code · 2026 CMS data · Verified 2026-08-31
CPT 22216 RVU and Medicare Payment (2026)
Incis addl spine segment — 5.88 work RVU, about $320.65 non-facility Medicare payment at the 2026 conversion factor.
- Work RVU
- 5.88
- PE RVU (non-facility)
- 1.95
- PE RVU (facility)
- 1.95
- MP RVU
- 1.77
- Office payment
- $320.65
- Facility payment
- $320.65
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 22216 in a non-facility setting with national GPCI: (5.88 + 1.95 + 1.77) × $33.4009 ≈ $320.65. The same code in a facility setting pays about $320.65 because facility PE RVU (1.95) replaces office PE RVU.
What changes by locality
GPCI moves 22216 non-facility payment from $277 to $413.71 across CMS localities — from Wisconsin to Miami. 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 22216?
5.88. 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 22216 in 2026?
About $320.65 non-facility ($320.65 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 (5.88) and malpractice RVU stay fixed; only practice expense changes (1.95 office vs 1.95 facility). That is the entire office-vs-facility payment gap.