{
    "code": "86078",
    "coding_system": "CPT",
    "canonical_url": "https://localishealth.com/cpt/86078",
    "release_specific_url": "https://localishealth.com/cpt/86078/2026/C",
    "answer": {
        "question": "How much does Medicare pay for CPT 86078 in 2026?",
        "text": "Medicare pays $51.44 for CPT 86078 in the office (non-facility) setting and $39.75 in a facility under the Q3 2026 Physician Fee Schedule, effective July 2026. These are the national allowed amounts before the ~2% sequestration cut and before locality (GPCI) adjustment. This price has been unchanged since Q1 2026, when it increased 0.6%."
    },
    "release": {
        "schedule": "pfs",
        "year": 2026,
        "quarter": "C",
        "label": "Q3 2026",
        "effective": "July 1 – September 30, 2026",
        "revision": 1
    },
    "status": {
        "code": "A",
        "non_facility_payable": true,
        "facility_payable": true
    },
    "national_rates_usd": {
        "office_non_facility": 51.44,
        "facility": 39.75,
        "sequestration_applied": false,
        "gpci": 1
    },
    "rvus": {
        "work": 0.92,
        "practice_expense_non_facility": 0.57,
        "practice_expense_facility": 0.22,
        "malpractice": 0.05
    },
    "formula": "(work_rvu × work_gpci + pe_rvu × pe_gpci + mp_rvu × mp_gpci) × conversion_factor",
    "conversion_factor": 33.4009,
    "ncci": {
        "release": "Q3 2026",
        "never_billable_pair_count": 1,
        "modifier_allowed_pair_count": 0,
        "mue_units_per_date_of_service": null,
        "url": "https://localishealth.com/cpt/86078/ncci-edits",
        "complete_text_url": "https://localishealth.com/cpt/86078/ncci-edits.txt"
    },
    "source": {
        "label": "Physician relative value file (Q3 2026)",
        "cms_url": "https://www.cms.gov/files/zip/rvu26c-updated-06-30-2026.zip",
        "local_source_url": "https://localishealth.com/sources/physician-fee-schedule/2026/C",
        "file": "PPRRVU2026_Jul_nonQPP.csv",
        "row": 10540,
        "sha256": "b7d197e73211ef6854c213c267d5fa9dec8df995db8e1ee7d44c0556ad7cee21"
    },
    "modified_at": "2026-08-04T03:16:41+00:00"
}