CPT / HCPCS code · 2026 CMS data · Verified 2026-08-31
CPT 40816 RVU and Medicare Payment (2026)
Excision of mouth lesion — 3.68 work RVU, about $408.49 non-facility Medicare payment at the 2026 conversion factor.
- Work RVU
- 3.68
- PE RVU (non-facility)
- 8.06
- PE RVU (facility)
- 4.21
- MP RVU
- 0.49
- Office payment
- $408.49
- Facility payment
- $279.9
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 40816 in a non-facility setting with national GPCI: (3.68 + 8.06 + 0.49) × $33.4009 ≈ $408.49. The same code in a facility setting pays about $279.9 because facility PE RVU (4.21) replaces office PE RVU.
What changes by locality
GPCI moves 40816 non-facility payment from $362.6 to $533.41 across CMS localities — from Arkansas to San Jose-sunnyvale-santa Clara (san Benito Cnty). 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 40816?
3.68. 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 40816 in 2026?
About $408.49 non-facility ($279.9 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 (3.68) and malpractice RVU stay fixed; only practice expense changes (8.06 office vs 4.21 facility). That is the entire office-vs-facility payment gap.