CPT / HCPCS code · 2026 CMS data · Verified 2026-08-31
CPT 96203 RVU and Medicare Payment (2026)
Mlt fam grp bhv train ea add — 0.12 work RVU, about $5.34 non-facility Medicare payment at the 2026 conversion factor.
- Work RVU
- 0.12
- PE RVU (non-facility)
- 0.03
- PE RVU (facility)
- 0.02
- MP RVU
- 0.01
- Office payment
- $5.34
- Facility payment
- $5.01
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 96203 in a non-facility setting with national GPCI: (0.12 + 0.03 + 0.01) × $33.4009 ≈ $5.34. The same code in a facility setting pays about $5.01 because facility PE RVU (0.02) replaces office PE RVU.
What changes by locality
GPCI moves 96203 non-facility payment from $5.04 to $7.26 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 96203?
0.12. 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 96203 in 2026?
About $5.34 non-facility ($5.01 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 (0.12) and malpractice RVU stay fixed; only practice expense changes (0.03 office vs 0.02 facility). That is the entire office-vs-facility payment gap.