CPT / HCPCS code · 2026 CMS data · Verified 2026-08-31
CPT 42120 RVU and Medicare Payment (2026)
Remove palate/lesion — 11.56 work RVU, about $912.18 non-facility Medicare payment at the 2026 conversion factor.
- Work RVU
- 11.56
- PE RVU (non-facility)
- 14.06
- PE RVU (facility)
- 14.06
- MP RVU
- 1.69
- Office payment
- $912.18
- Facility payment
- $912.18
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 42120 in a non-facility setting with national GPCI: (11.56 + 14.06 + 1.69) × $33.4009 ≈ $912.18. The same code in a facility setting pays about $912.18 because facility PE RVU (14.06) replaces office PE RVU.
What changes by locality
GPCI moves 42120 non-facility payment from $818.59 to $1,136.03 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 42120?
11.56. 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 42120 in 2026?
About $912.18 non-facility ($912.18 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 (11.56) and malpractice RVU stay fixed; only practice expense changes (14.06 office vs 14.06 facility). That is the entire office-vs-facility payment gap.