CPT / HCPCS code · 2026 CMS data · Verified 2026-08-31
CPT 68816 RVU and Medicare Payment (2026)
Probe nl duct w/balloon — 2.05 work RVU, about $831.68 non-facility Medicare payment at the 2026 conversion factor.
- Work RVU
- 2.05
- PE RVU (non-facility)
- 22.69
- PE RVU (facility)
- 1.8
- MP RVU
- 0.16
- Office payment
- $831.68
- Facility payment
- $133.94
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 68816 in a non-facility setting with national GPCI: (2.05 + 22.69 + 0.16) × $33.4009 ≈ $831.68. The same code in a facility setting pays about $133.94 because facility PE RVU (1.8) replaces office PE RVU.
What changes by locality
GPCI moves 68816 non-facility payment from $722.23 to $1,171.71 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 68816?
2.05. 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 68816 in 2026?
About $831.68 non-facility ($133.94 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 (2.05) and malpractice RVU stay fixed; only practice expense changes (22.69 office vs 1.8 facility). That is the entire office-vs-facility payment gap.