CPT / HCPCS code · 2026 CMS data · Verified 2026-08-31
CPT 42227 RVU and Medicare Payment (2026)
Lengthening of palate — 9.65 work RVU, about $774.9 non-facility Medicare payment at the 2026 conversion factor.
- Work RVU
- 9.65
- PE RVU (non-facility)
- 12.15
- PE RVU (facility)
- 12.15
- MP RVU
- 1.4
- Office payment
- $774.9
- Facility payment
- $774.9
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 42227 in a non-facility setting with national GPCI: (9.65 + 12.15 + 1.4) × $33.4009 ≈ $774.9. The same code in a facility setting pays about $774.9 because facility PE RVU (12.15) replaces office PE RVU.
What changes by locality
GPCI moves 42227 non-facility payment from $695 to $968.03 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 42227?
9.65. 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 42227 in 2026?
About $774.9 non-facility ($774.9 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 (9.65) and malpractice RVU stay fixed; only practice expense changes (12.15 office vs 12.15 facility). That is the entire office-vs-facility payment gap.