CPT / HCPCS code · 2026 CMS data · Verified 2026-08-31
CPT 42972 RVU and Medicare Payment (2026)
Control nose/throat bleeding — 7.4 work RVU, about $444.57 non-facility Medicare payment at the 2026 conversion factor.
- Work RVU
- 7.4
- PE RVU (non-facility)
- 4.83
- PE RVU (facility)
- 4.83
- MP RVU
- 1.08
- Office payment
- $444.57
- Facility payment
- $444.57
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 42972 in a non-facility setting with national GPCI: (7.4 + 4.83 + 1.08) × $33.4009 ≈ $444.57. The same code in a facility setting pays about $444.57 because facility PE RVU (4.83) replaces office PE RVU.
What changes by locality
GPCI moves 42972 non-facility payment from $404.32 to $562.44 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 42972?
7.4. 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 42972 in 2026?
About $444.57 non-facility ($444.57 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 (7.4) and malpractice RVU stay fixed; only practice expense changes (4.83 office vs 4.83 facility). That is the entire office-vs-facility payment gap.