CPT / HCPCS code · 2026 CMS data · Verified 2026-08-31
CPT 96131 RVU and Medicare Payment (2026)
Psycl tst eval phys/qhp ea — 1.96 work RVU, about $86.51 non-facility Medicare payment at the 2026 conversion factor.
- Work RVU
- 1.96
- PE RVU (non-facility)
- 0.62
- PE RVU (facility)
- 0.13
- MP RVU
- 0.01
- Office payment
- $86.51
- Facility payment
- $70.14
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 96131 in a non-facility setting with national GPCI: (1.96 + 0.62 + 0.01) × $33.4009 ≈ $86.51. The same code in a facility setting pays about $70.14 because facility PE RVU (0.13) replaces office PE RVU.
What changes by locality
GPCI moves 96131 non-facility payment from $83.43 to $120.44 across CMS localities — from Arkansas 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 96131?
1.96. 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 96131 in 2026?
About $86.51 non-facility ($70.14 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 (1.96) and malpractice RVU stay fixed; only practice expense changes (0.62 office vs 0.13 facility). That is the entire office-vs-facility payment gap.