CPT / HCPCS code · 2026 CMS data · Verified 2026-08-31
CPT 42890 RVU and Medicare Payment (2026)
Limited pharyngectomy — 18.65 work RVU, about $1,255.21 non-facility Medicare payment at the 2026 conversion factor.
- Work RVU
- 18.65
- PE RVU (non-facility)
- 16.17
- PE RVU (facility)
- 16.17
- MP RVU
- 2.76
- Office payment
- $1,255.21
- Facility payment
- $1,255.21
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 42890 in a non-facility setting with national GPCI: (18.65 + 16.17 + 2.76) × $33.4009 ≈ $1,255.21. The same code in a facility setting pays about $1,255.21 because facility PE RVU (16.17) replaces office PE RVU.
What changes by locality
GPCI moves 42890 non-facility payment from $1,134.34 to $1,560.38 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 42890?
18.65. 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 42890 in 2026?
About $1,255.21 non-facility ($1,255.21 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 (18.65) and malpractice RVU stay fixed; only practice expense changes (16.17 office vs 16.17 facility). That is the entire office-vs-facility payment gap.