CPT / HCPCS code · 2026 CMS data · Verified 2026-08-31
CPT 42720 RVU and Medicare Payment (2026)
I&d absc phrngl ntraorl appr — 6.15 work RVU, about $446.57 non-facility Medicare payment at the 2026 conversion factor.
- Work RVU
- 6.15
- PE RVU (non-facility)
- 6.31
- PE RVU (facility)
- 2.94
- MP RVU
- 0.91
- Office payment
- $446.57
- Facility payment
- $334.01
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 42720 in a non-facility setting with national GPCI: (6.15 + 6.31 + 0.91) × $33.4009 ≈ $446.57. The same code in a facility setting pays about $334.01 because facility PE RVU (2.94) replaces office PE RVU.
What changes by locality
GPCI moves 42720 non-facility payment from $402.11 to $549.33 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 42720?
6.15. 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 42720 in 2026?
About $446.57 non-facility ($334.01 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 (6.15) and malpractice RVU stay fixed; only practice expense changes (6.31 office vs 2.94 facility). That is the entire office-vs-facility payment gap.