CPT / HCPCS code · 2026 CMS data · Verified 2026-08-31
CPT 99156 RVU and Medicare Payment (2026)
Mod sed oth phys/qhp 5/>yrs — 1.65 work RVU, about $71.14 non-facility Medicare payment at the 2026 conversion factor.
- Work RVU
- 1.65
- PE RVU (non-facility)
- 0.29
- PE RVU (facility)
- 0.29
- MP RVU
- 0.19
- Office payment
- $71.14
- Facility payment
- $71.14
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 99156 in a non-facility setting with national GPCI: (1.65 + 0.29 + 0.19) × $33.4009 ≈ $71.14. The same code in a facility setting pays about $71.14 because facility PE RVU (0.29) replaces office PE RVU.
What changes by locality
GPCI moves 99156 non-facility payment from $66.35 to $96.48 across CMS localities — from Wisconsin 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 99156?
1.65. 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 99156 in 2026?
About $71.14 non-facility ($71.14 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 (1.65) and malpractice RVU stay fixed; only practice expense changes (0.29 office vs 0.29 facility). That is the entire office-vs-facility payment gap.