CPT / HCPCS code · 2026 CMS data · Verified 2026-08-31
CPT 42200 RVU and Medicare Payment (2026)
Reconstruct cleft palate — 12.22 work RVU, about $842.7 non-facility Medicare payment at the 2026 conversion factor.
- Work RVU
- 12.22
- PE RVU (non-facility)
- 10.74
- PE RVU (facility)
- 10.74
- MP RVU
- 2.27
- Office payment
- $842.7
- Facility payment
- $842.7
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 42200 in a non-facility setting with national GPCI: (12.22 + 10.74 + 2.27) × $33.4009 ≈ $842.7. The same code in a facility setting pays about $842.7 because facility PE RVU (10.74) replaces office PE RVU.
What changes by locality
GPCI moves 42200 non-facility payment from $755.35 to $1,036.06 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 42200?
12.22. 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 42200 in 2026?
About $842.7 non-facility ($842.7 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 (12.22) and malpractice RVU stay fixed; only practice expense changes (10.74 office vs 10.74 facility). That is the entire office-vs-facility payment gap.