CPT / HCPCS code · 2026 CMS data · Verified 2026-08-31
CPT 96168 RVU and Medicare Payment (2026)
Hlth bhv ivntj fam ea addl — 0.63 work RVU, about $28.39 non-facility Medicare payment at the 2026 conversion factor.
- Work RVU
- 0.63
- PE RVU (non-facility)
- 0.21
- PE RVU (facility)
- 0.04
- MP RVU
- 0.01
- Office payment
- $28.39
- Facility payment
- $22.71
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 96168 in a non-facility setting with national GPCI: (0.63 + 0.21 + 0.01) × $33.4009 ≈ $28.39. The same code in a facility setting pays about $22.71 because facility PE RVU (0.04) replaces office PE RVU.
What changes by locality
GPCI moves 96168 non-facility payment from $27.24 to $39.22 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 96168?
0.63. 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 96168 in 2026?
About $28.39 non-facility ($22.71 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 (0.63) and malpractice RVU stay fixed; only practice expense changes (0.21 office vs 0.04 facility). That is the entire office-vs-facility payment gap.