CPT / HCPCS code · 2026 CMS data · Verified 2026-08-31
CPT 42820 RVU and Medicare Payment (2026)
Remove tonsils and adenoids — 4.11 work RVU, about $260.86 non-facility Medicare payment at the 2026 conversion factor.
- Work RVU
- 4.11
- PE RVU (non-facility)
- 3.11
- PE RVU (facility)
- 3.11
- MP RVU
- 0.59
- Office payment
- $260.86
- Facility payment
- $260.86
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 42820 in a non-facility setting with national GPCI: (4.11 + 3.11 + 0.59) × $33.4009 ≈ $260.86. The same code in a facility setting pays about $260.86 because facility PE RVU (3.11) replaces office PE RVU.
What changes by locality
GPCI moves 42820 non-facility payment from $236.66 to $327.4 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 42820?
4.11. 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 42820 in 2026?
About $260.86 non-facility ($260.86 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 (4.11) and malpractice RVU stay fixed; only practice expense changes (3.11 office vs 3.11 facility). That is the entire office-vs-facility payment gap.