CPT / HCPCS code · 2026 CMS data · Verified 2026-08-31
CPT 96161 RVU and Medicare Payment (2026)
Caregiver health risk assmt — 0 work RVU, about $3.34 non-facility Medicare payment at the 2026 conversion factor.
- Work RVU
- 0
- PE RVU (non-facility)
- 0.1
- PE RVU (facility)
- 0.1
- MP RVU
- 0
- Office payment
- $3.34
- Facility payment
- $3.34
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 96161 in a non-facility setting with national GPCI: (0 + 0.1 + 0) × $33.4009 ≈ $3.34. The same code in a facility setting pays about $3.34 because facility PE RVU (0.1) replaces office PE RVU.
What changes by locality
GPCI moves 96161 non-facility payment from $2.87 to $4.82 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 96161?
0. 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 96161 in 2026?
About $3.34 non-facility ($3.34 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) and malpractice RVU stay fixed; only practice expense changes (0.1 office vs 0.1 facility). That is the entire office-vs-facility payment gap.