CPT / HCPCS code · 2026 CMS data · Verified 2026-08-31
CPT 42975 RVU and Medicare Payment (2026)
Dise eval slp do brth flx dx — 1.54 work RVU, about $83.5 non-facility Medicare payment at the 2026 conversion factor.
- Work RVU
- 1.54
- PE RVU (non-facility)
- 0.75
- PE RVU (facility)
- 0.75
- MP RVU
- 0.21
- Office payment
- $83.5
- Facility payment
- $83.5
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 42975 in a non-facility setting with national GPCI: (1.54 + 0.75 + 0.21) × $33.4009 ≈ $83.5. The same code in a facility setting pays about $83.5 because facility PE RVU (0.75) replaces office PE RVU.
What changes by locality
GPCI moves 42975 non-facility payment from $76.57 to $107.7 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 42975?
1.54. 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 42975 in 2026?
About $83.5 non-facility ($83.5 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 (1.54) and malpractice RVU stay fixed; only practice expense changes (0.75 office vs 0.75 facility). That is the entire office-vs-facility payment gap.