CPT / HCPCS code · 2026 CMS data · Verified 2026-08-31
CPT 78496 RVU and Medicare Payment (2026)
Heart first pass add-on — 0.49 work RVU, about $42.42 non-facility Medicare payment at the 2026 conversion factor.
- Work RVU
- 0.49
- PE RVU (non-facility)
- 0.75
- PE RVU (facility)
- 0.75
- MP RVU
- 0.03
- Office payment
- $42.42
- Facility payment
- $42.42
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 78496 in a non-facility setting with national GPCI: (0.49 + 0.75 + 0.03) × $33.4009 ≈ $42.42. The same code in a facility setting pays about $42.42 because facility PE RVU (0.75) replaces office PE RVU.
What changes by locality
GPCI moves 78496 non-facility payment from $38.4 to $54.83 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 78496?
0.49. 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 78496 in 2026?
About $42.42 non-facility ($42.42 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 (0.49) and malpractice RVU stay fixed; only practice expense changes (0.75 office vs 0.75 facility). That is the entire office-vs-facility payment gap.