# CPT 42820

> Medicare pays $260.86 for CPT 42820 in the office (non-facility) setting and $260.86 in a facility under the Q4 2026 Physician Fee Schedule, effective October 2026. These are the national allowed amounts before the ~2% sequestration cut and before locality (GPCI) adjustment. Across payment localities, both settings' amount is $236.66–$327.40. This price has been unchanged since Q1 2026, when it decreased 9.3%.

## Selected release

- Release: Q4 2026 (2026 D)
- Effective: October 1 – December 31, 2026
- Status indicator: A
- Office (non-facility) national allowed amount: $260.86
- Facility national allowed amount: $260.86
- Sequestration: not applied

## RVUs and formula

- Work RVU: 4.11
- Office (non-facility) practice expense RVU: 3.11
- Facility practice expense RVU: 3.11
- Malpractice RVU: 0.59
- Conversion factor: 33.4009
- Formula: `(work_rvu × work_gpci + pe_rvu × pe_gpci + mp_rvu × mp_gpci) × conversion_factor`

## NCCI edits

- Never-billable pair count: 76
- Modifier-allowed pair count: 177
- MUE units per patient per date of service: not published
- Complete list: https://localishealth.com/cpt/42820/ncci-edits.txt

## Source and citation

- Source: Physician relative value file (Q4 2026)
- CMS file: https://www.cms.gov/files/zip/rvu26d.zip
- Parsed file: PPRRVU2026_Oct_nonQPP.csv, row 5,079
- Canonical page: https://localishealth.com/cpt/42820
- Release-specific citation URL: https://localishealth.com/cpt/42820/2026/D
- Last significant update: 2026-08-26T06:15:42+00:00