CPT / HCPCS code · 2026 CMS data · Verified 2026-08-31
CPT 96405 RVU and Medicare Payment (2026)
Chemo intralesional up to 7 — 0.52 work RVU, about $84.5 non-facility Medicare payment at the 2026 conversion factor.
- Work RVU
- 0.52
- PE RVU (non-facility)
- 1.98
- PE RVU (facility)
- 0.16
- MP RVU
- 0.03
- Office payment
- $84.5
- Facility payment
- $23.71
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 96405 in a non-facility setting with national GPCI: (0.52 + 1.98 + 0.03) × $33.4009 ≈ $84.5. The same code in a facility setting pays about $23.71 because facility PE RVU (0.16) replaces office PE RVU.
What changes by locality
GPCI moves 96405 non-facility payment from $74.69 to $115.18 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 96405?
0.52. 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 96405 in 2026?
About $84.5 non-facility ($23.71 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 (0.52) and malpractice RVU stay fixed; only practice expense changes (1.98 office vs 0.16 facility). That is the entire office-vs-facility payment gap.