CPT / HCPCS code · 2026 CMS data · Verified 2026-08-31
CPT 42500 RVU and Medicare Payment (2026)
Repair salivary duct — 4.31 work RVU, about $448.91 non-facility Medicare payment at the 2026 conversion factor.
- Work RVU
- 4.31
- PE RVU (non-facility)
- 8.51
- PE RVU (facility)
- 4.45
- MP RVU
- 0.62
- Office payment
- $448.91
- Facility payment
- $313.3
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 42500 in a non-facility setting with national GPCI: (4.31 + 8.51 + 0.62) × $33.4009 ≈ $448.91. The same code in a facility setting pays about $313.3 because facility PE RVU (4.45) replaces office PE RVU.
What changes by locality
GPCI moves 42500 non-facility payment from $398.79 to $580.77 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 42500?
4.31. 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 42500 in 2026?
About $448.91 non-facility ($313.3 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 (4.31) and malpractice RVU stay fixed; only practice expense changes (8.51 office vs 4.45 facility). That is the entire office-vs-facility payment gap.