CPT / HCPCS code · 2026 CMS data · Verified 2026-08-31
CPT 31242 RVU and Medicare Payment (2026)
Nsl/sinus ndsc rf abltj pnn — 2.63 work RVU, about $2,395.51 non-facility Medicare payment at the 2026 conversion factor.
- Work RVU
- 2.63
- PE RVU (non-facility)
- 68.7
- PE RVU (facility)
- 1.02
- MP RVU
- 0.39
- Office payment
- $2,395.51
- Facility payment
- $134.94
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 31242 in a non-facility setting with national GPCI: (2.63 + 68.7 + 0.39) × $33.4009 ≈ $2,395.51. The same code in a facility setting pays about $134.94 because facility PE RVU (1.02) replaces office PE RVU.
What changes by locality
GPCI moves 31242 non-facility payment from $2,065.65 to $3,413.36 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 31242?
2.63. 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 31242 in 2026?
About $2,395.51 non-facility ($134.94 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 (2.63) and malpractice RVU stay fixed; only practice expense changes (68.7 office vs 1.02 facility). That is the entire office-vs-facility payment gap.