CPT 67042 RVU Values & Medicare Payment 2026
Vit for macular hole
Code-level payment context
review the code record, calculate payment with fixed assumptions, compare locality or setting effects, and route into benchmark review when needed.
- Input
- CPT 67042, setting, participant status, and locality
- Source basis
- CMS 2026 CPT/HCPCS RVU components, typical setting, 2026 conversion factor assumption, GPCI locality examples, and related-code mapping.
- Result boundary
- The page is not coding advice and does not validate code selection, payer-specific edits, modifier rules, or documentation support.
CPT 67042 is calculated with its CMS 2026 RVU components, the National Average GPCI locality, the non-facility practice expense setting, and the non-QPP conversion factor.
2026/rvu26b
2026-03-10
CPT or HCPCS code, Work RVU, Practice expense RVU, Malpractice RVU, GPCI locality, Conversion factor
CPT 67042 landing page payment provenance. The calculation uses CMS April 2026 RVU records, GPCI localities, and conversion factors. Verify official CMS and payer rules before billing or contract decisions.
- CPT or HCPCS code: CMS PFS Relative Value Files RVU record and descriptor fields
- Work RVU: CMS PFS Relative Value Files work RVU component
- Practice expense RVU: CMS PFS Relative Value Files facility and non-facility PE RVU fields
- Malpractice RVU: CMS PFS Relative Value Files malpractice RVU component
CPT 67042 setting and related-code comparison
Compare the same CPT under both PE settings, then review adjacent codes using National Average GPCI and the selected 2026 conversion factor.
| Setting | Work RVU | PE RVU | MP RVU | Total RVU | Payment |
|---|---|---|---|---|---|
| Non-facility | 15.92 | 11.39 | 1.27 | 28.58 | $954.60 |
| Facility | 15.92 | 11.39 | 1.27 | 28.58 | $954.60 |
| Related CPT | Descriptor | wRVU | Typical setting | National payment |
|---|---|---|---|---|
| CPT 67040 | Laser treatment of retina | 14.14 | Non-facility | $869.76 |
| CPT 67041 | Vit for macular pucker | 15.92 | Non-facility | $954.93 |
| CPT 67043 | Vit for membrane dissect | 16.97 | Non-facility | $1,004.70 |
| CPT 67101 | Repair detached retina crtx | 3.41 | Non-facility | $335.35 |
| CPT 99214 | Office o/p est mod 30 min | 1.92 | Non-facility | $135.61 |
CPT RVU and Medicare payment calculator
Search a CPT code, choose geography and participation status, then review work RVU, PE RVU, MP RVU, total RVU, and estimated Medicare payment. Use work RVU for productivity context and total RVU for Medicare payment estimates.
28.58 total RVU in National Average, National.
- Payment estimate: use total RVU and non-QPP $33.4009 for Medicare payment review.
- Productivity review: use work RVU separately; total RVU is not a physician productivity target.
- Before relying on it: confirm office / non-facility, National Average, and payer-specific billing rules.
Total RVU = work RVU x GPCI work + PE RVU x GPCI PE + MP RVU x GPCI MP. Payment = total RVU x selected 2026 conversion factor. Non-QPP uses $33.4009 and QPP uses $33.5675.
- CPT
- 67042
- Setting
- office / non-facility
- Conversion factor
- non-QPP $33.4009
- Work GPCI
- 1.000
- PE GPCI
- 1.000
- MP GPCI
- 1.000
2026/rvu26b
2026-03-10
CPT or HCPCS code, Work RVU, Practice expense RVU, Malpractice RVU, GPCI locality, Conversion factor
CPT 67042 result provenance. The calculation uses CMS April 2026 RVU records, GPCI localities, and conversion factors. Verify official CMS and payer rules before billing or contract decisions.
- CPT or HCPCS code: CMS PFS Relative Value Files RVU record and descriptor fields
- Work RVU: CMS PFS Relative Value Files work RVU component
- Practice expense RVU: CMS PFS Relative Value Files facility and non-facility PE RVU fields
- Malpractice RVU: CMS PFS Relative Value Files malpractice RVU component
Keep this CPT, setting, locality, and conversion factor fixed when moving into geography, contract, or benchmark review.
Payment by representative localities
| Locality | wRVU | Total RVU | Medicare Payment |
|---|---|---|---|
| National: National Average | 15.92 | 28.58 | $954.60 |
| California: San Francisco | 15.92 | 32.45 | $1,083.70 |
| California: Los Angeles | 15.92 | 30.75 | $1,027.16 |
| New York: Manhattan | 15.92 | 32.19 | $1,075.12 |
| New York: Rest of New York | 15.92 | 29.82 | $996.04 |
| Texas: Dallas | 15.92 | 28.50 | $951.84 |
| Texas: Houston | 15.92 | 29.11 | $972.14 |
| Florida: Miami | 15.92 | 30.99 | $1,035.05 |
CPT 67042 code profile
CMS 2026 Physician Fee Schedule inputs for this CPT/HCPCS code, including the site-of-service assumption used for the payment examples on this page.
Vit for macular hole
- Typical setting
- Office / non-facility
- Specialty mapping
- Internal Medicine
- Related codes
- 67040, 67041, 67043, 67101, 99214
RVU components are payment inputs, not clinical coding guidance. Confirm code selection, modifiers, payer policy, and documentation requirements through the official CMS source files or billing review. Locality-adjusted estimates should be interpreted with the selected setting, GPCI locality, and QPP status held constant.
CPT FAQ
Common RVU and payment questions for CPT 67042.
What is the wRVU for CPT 67042?
The imported CMS 2026 Physician Fee Schedule source files list 15.92 work RVU for CPT 67042.
What is the national payment estimate for CPT 67042?
Using national GPCI and the 2026 non-QPP conversion factor, the estimate is $954.60.
Does locality change the payment?
Yes. GPCI values adjust work, practice expense, and malpractice components by geography.