CPT / HCPCS code · 2026 CMS data · Verified 2026-08-31
CPT 96167 RVU and Medicare Payment (2026)
Hlth bhv ivntj fam 1st 30 — 1.77 work RVU, about $78.16 non-facility Medicare payment at the 2026 conversion factor.
- Work RVU
- 1.77
- PE RVU (non-facility)
- 0.56
- PE RVU (facility)
- 0.11
- MP RVU
- 0.01
- Office payment
- $78.16
- Facility payment
- $63.13
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 96167 in a non-facility setting with national GPCI: (1.77 + 0.56 + 0.01) × $33.4009 ≈ $78.16. The same code in a facility setting pays about $63.13 because facility PE RVU (0.11) replaces office PE RVU.
What changes by locality
GPCI moves 96167 non-facility payment from $75.36 to $108.78 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 96167?
1.77. 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 96167 in 2026?
About $78.16 non-facility ($63.13 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 (1.77) and malpractice RVU stay fixed; only practice expense changes (0.56 office vs 0.11 facility). That is the entire office-vs-facility payment gap.