CPT / HCPCS code · 2026 CMS data · Verified 2026-08-31
CPT G0516 RVU and Medicare Payment (2026)
Insert drug del implant, >=4 — 1.77 work RVU, about $175.02 non-facility Medicare payment at the 2026 conversion factor.
- Work RVU
- 1.77
- PE RVU (non-facility)
- 3.32
- PE RVU (facility)
- 0.62
- MP RVU
- 0.15
- Office payment
- $175.02
- Facility payment
- $84.84
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 G0516 in a non-facility setting with national GPCI: (1.77 + 3.32 + 0.15) × $33.4009 ≈ $175.02. The same code in a facility setting pays about $84.84 because facility PE RVU (0.62) replaces office PE RVU.
What changes by locality
GPCI moves G0516 non-facility payment from $156.96 to $228.21 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 G0516?
1.77. 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 G0516 in 2026?
About $175.02 non-facility ($84.84 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 (1.77) and malpractice RVU stay fixed; only practice expense changes (3.32 office vs 0.62 facility). That is the entire office-vs-facility payment gap.