CPT / HCPCS code · 2026 CMS data · Verified 2026-08-31
CPT 98967 RVU and Medicare Payment (2026)
Ph1 assmt&mgmt nqhp 11-20 — 0.5 work RVU, about $25.05 non-facility Medicare payment at the 2026 conversion factor.
- Work RVU
- 0.5
- PE RVU (non-facility)
- 0.23
- PE RVU (facility)
- 0.08
- MP RVU
- 0.02
- Office payment
- $25.05
- Facility payment
- $20.04
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 98967 in a non-facility setting with national GPCI: (0.5 + 0.23 + 0.02) × $33.4009 ≈ $25.05. The same code in a facility setting pays about $20.04 because facility PE RVU (0.08) replaces office PE RVU.
What changes by locality
GPCI moves 98967 non-facility payment from $23.64 to $33.6 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 98967?
0.5. 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 98967 in 2026?
About $25.05 non-facility ($20.04 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 (0.5) and malpractice RVU stay fixed; only practice expense changes (0.23 office vs 0.08 facility). That is the entire office-vs-facility payment gap.