CPT / HCPCS code · 2026 CMS data · Verified 2026-08-31
CPT 42220 RVU and Medicare Payment (2026)
Reconstruct cleft palate — 6.98 work RVU, about $539.42 non-facility Medicare payment at the 2026 conversion factor.
- Work RVU
- 6.98
- PE RVU (non-facility)
- 7.87
- PE RVU (facility)
- 7.87
- MP RVU
- 1.3
- Office payment
- $539.42
- Facility payment
- $539.42
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 42220 in a non-facility setting with national GPCI: (6.98 + 7.87 + 1.3) × $33.4009 ≈ $539.42. The same code in a facility setting pays about $539.42 because facility PE RVU (7.87) replaces office PE RVU.
What changes by locality
GPCI moves 42220 non-facility payment from $481.3 to $661.11 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 42220?
6.98. 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 42220 in 2026?
About $539.42 non-facility ($539.42 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 (6.98) and malpractice RVU stay fixed; only practice expense changes (7.87 office vs 7.87 facility). That is the entire office-vs-facility payment gap.