CPT / HCPCS code · 2026 CMS data · Verified 2026-08-31
CPT 67042 RVU and Medicare Payment (2026)
Vit for macular hole — 15.92 work RVU, about $954.6 non-facility Medicare payment at the 2026 conversion factor.
- Work RVU
- 15.92
- PE RVU (non-facility)
- 11.39
- PE RVU (facility)
- 11.39
- MP RVU
- 1.27
- Office payment
- $954.6
- Facility payment
- $954.6
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 67042 in a non-facility setting with national GPCI: (15.92 + 11.39 + 1.27) × $33.4009 ≈ $954.6. The same code in a facility setting pays about $954.6 because facility PE RVU (11.39) replaces office PE RVU.
What changes by locality
GPCI moves 67042 non-facility payment from $880.38 to $1,226.15 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 67042?
15.92. 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 67042 in 2026?
About $954.6 non-facility ($954.6 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 (15.92) and malpractice RVU stay fixed; only practice expense changes (11.39 office vs 11.39 facility). That is the entire office-vs-facility payment gap.