CPT / HCPCS code · 2026 CMS data · Verified 2026-08-31
CPT 42226 RVU and Medicare Payment (2026)
Lengthening of palate — 10.09 work RVU, about $834.69 non-facility Medicare payment at the 2026 conversion factor.
- Work RVU
- 10.09
- PE RVU (non-facility)
- 13.43
- PE RVU (facility)
- 13.43
- MP RVU
- 1.47
- Office payment
- $834.69
- Facility payment
- $834.69
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 42226 in a non-facility setting with national GPCI: (10.09 + 13.43 + 1.47) × $33.4009 ≈ $834.69. The same code in a facility setting pays about $834.69 because facility PE RVU (13.43) replaces office PE RVU.
What changes by locality
GPCI moves 42226 non-facility payment from $747.63 to $1,047.25 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 42226?
10.09. 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 42226 in 2026?
About $834.69 non-facility ($834.69 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 (10.09) and malpractice RVU stay fixed; only practice expense changes (13.43 office vs 13.43 facility). That is the entire office-vs-facility payment gap.