CPT / HCPCS code · 2026 CMS data · Verified 2026-08-31
CPT 42145 RVU and Medicare Payment (2026)
Repair palate pharynx/uvula — 9.54 work RVU, about $608.56 non-facility Medicare payment at the 2026 conversion factor.
- Work RVU
- 9.54
- PE RVU (non-facility)
- 7.29
- PE RVU (facility)
- 7.29
- MP RVU
- 1.39
- Office payment
- $608.56
- Facility payment
- $608.56
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 42145 in a non-facility setting with national GPCI: (9.54 + 7.29 + 1.39) × $33.4009 ≈ $608.56. The same code in a facility setting pays about $608.56 because facility PE RVU (7.29) replaces office PE RVU.
What changes by locality
GPCI moves 42145 non-facility payment from $551.71 to $762.87 across CMS localities — from Arkansas to Alaska. 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 42145?
9.54. 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 42145 in 2026?
About $608.56 non-facility ($608.56 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 (9.54) and malpractice RVU stay fixed; only practice expense changes (7.29 office vs 7.29 facility). That is the entire office-vs-facility payment gap.