CPT / HCPCS code · 2026 CMS data · Verified 2026-08-31
CPT 42860 RVU and Medicare Payment (2026)
Excision of tonsil tags — 2.24 work RVU, about $179.7 non-facility Medicare payment at the 2026 conversion factor.
- Work RVU
- 2.24
- PE RVU (non-facility)
- 2.8
- PE RVU (facility)
- 2.8
- MP RVU
- 0.34
- Office payment
- $179.7
- Facility payment
- $179.7
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 42860 in a non-facility setting with national GPCI: (2.24 + 2.8 + 0.34) × $33.4009 ≈ $179.7. The same code in a facility setting pays about $179.7 because facility PE RVU (2.8) replaces office PE RVU.
What changes by locality
GPCI moves 42860 non-facility payment from $161 to $223.99 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 42860?
2.24. 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 42860 in 2026?
About $179.7 non-facility ($179.7 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 (2.24) and malpractice RVU stay fixed; only practice expense changes (2.8 office vs 2.8 facility). That is the entire office-vs-facility payment gap.