CPT / HCPCS code · 2026 CMS data · Verified 2026-08-31
CPT 96165 RVU and Medicare Payment (2026)
Hlth bhv ivntj grp ea addl — 0.11 work RVU, about $5.01 non-facility Medicare payment at the 2026 conversion factor.
- Work RVU
- 0.11
- PE RVU (non-facility)
- 0.04
- PE RVU (facility)
- 0.01
- MP RVU
- 0
- Office payment
- $5.01
- Facility payment
- $4.01
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 96165 in a non-facility setting with national GPCI: (0.11 + 0.04 + 0) × $33.4009 ≈ $5.01. The same code in a facility setting pays about $4.01 because facility PE RVU (0.01) replaces office PE RVU.
What changes by locality
GPCI moves 96165 non-facility payment from $4.82 to $6.93 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 96165?
0.11. 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 96165 in 2026?
About $5.01 non-facility ($4.01 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 (0.11) and malpractice RVU stay fixed; only practice expense changes (0.04 office vs 0.01 facility). That is the entire office-vs-facility payment gap.