CPT / HCPCS code · 2026 CMS data · Verified 2026-08-31
CPT 96158 RVU and Medicare Payment (2026)
Hlth bhv ivntj indiv 1st 30 — 1.66 work RVU, about $73.82 non-facility Medicare payment at the 2026 conversion factor.
- Work RVU
- 1.66
- PE RVU (non-facility)
- 0.54
- PE RVU (facility)
- 0.12
- MP RVU
- 0.01
- Office payment
- $73.82
- Facility payment
- $59.79
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 96158 in a non-facility setting with national GPCI: (1.66 + 0.54 + 0.01) × $33.4009 ≈ $73.82. The same code in a facility setting pays about $59.79 because facility PE RVU (0.12) replaces office PE RVU.
What changes by locality
GPCI moves 96158 non-facility payment from $71.11 to $102.56 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 96158?
1.66. 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 96158 in 2026?
About $73.82 non-facility ($59.79 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 (1.66) and malpractice RVU stay fixed; only practice expense changes (0.54 office vs 0.12 facility). That is the entire office-vs-facility payment gap.