CPT / HCPCS code · 2026 CMS data · Verified 2026-08-31
CPT G0416 RVU and Medicare Payment (2026)
Prostate biopsy, any mthd — 3.51 work RVU, about $356.72 non-facility Medicare payment at the 2026 conversion factor.
- Work RVU
- 3.51
- PE RVU (non-facility)
- 7.06
- PE RVU (facility)
- 7.06
- MP RVU
- 0.11
- Office payment
- $356.72
- Facility payment
- $356.72
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 G0416 in a non-facility setting with national GPCI: (3.51 + 7.06 + 0.11) × $33.4009 ≈ $356.72. The same code in a facility setting pays about $356.72 because facility PE RVU (7.06) replaces office PE RVU.
What changes by locality
GPCI moves G0416 non-facility payment from $321.69 to $472.14 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 G0416?
3.51. 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 G0416 in 2026?
About $356.72 non-facility ($356.72 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 (3.51) and malpractice RVU stay fixed; only practice expense changes (7.06 office vs 7.06 facility). That is the entire office-vs-facility payment gap.