CPT / HCPCS code · 2026 CMS data · Verified 2026-08-31
CPT 42806 RVU and Medicare Payment (2026)
Biopsy of upper nose/throat — 1.59 work RVU, about $240.49 non-facility Medicare payment at the 2026 conversion factor.
- Work RVU
- 1.59
- PE RVU (non-facility)
- 5.39
- PE RVU (facility)
- 2.04
- MP RVU
- 0.22
- Office payment
- $240.49
- Facility payment
- $128.59
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 42806 in a non-facility setting with national GPCI: (1.59 + 5.39 + 0.22) × $33.4009 ≈ $240.49. The same code in a facility setting pays about $128.59 because facility PE RVU (2.04) replaces office PE RVU.
What changes by locality
GPCI moves 42806 non-facility payment from $211.54 to $322.49 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 42806?
1.59. 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 42806 in 2026?
About $240.49 non-facility ($128.59 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 (1.59) and malpractice RVU stay fixed; only practice expense changes (5.39 office vs 2.04 facility). That is the entire office-vs-facility payment gap.