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CMS RVU26D · Effective 2026-10-01
42900 Medicare reimbursement rates in Wisconsin
Compare 42900 physician payment amounts across CMS localities, including office and facility settings.
Amounts below use the non-QP conversion factor for participating physicians. These are base physician payments before claim-level adjustments, not patient costs or total hospital charges.
What does Medicare pay for 42900 in Wisconsin?
Wisconsin has 1 payment locality in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the payment area shown below, using the same CMS release.
Office / nonfacility
No supported rate
Facility setting
$267.52
1 of 1 localities have a supported rate.
Payment area: Wisconsin
One mapped payment locality.
These are locality ranges, not averages or address-specific quotes. A facility-setting amount covers the physician service; it does not include a hospital’s separate bill. Choose a locality below to inspect its calculation, compare other payment areas, or price a percentage of Medicare.
CPT Category I
About 42900
CMS billing rules for 42900
- Global period
- Minor procedure with a 10-day global period: related postoperative visits for 10 days are included.
- Multiple procedures
- Standard multiple procedure reduction: the highest-valued procedure is paid in full and others at 50% when performed in the same session.
- Bilateral procedures
- Bilateral adjustment does not apply; the descriptor or anatomy makes modifier 50 inappropriate.
- Assistant at surgery
- Assistant at surgery is paid only with documentation of medical necessity.
- Co-surgeons
- Co-surgeons not permitted.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU5.16 · 60%
- Practice expense (office) RVU2.73 · 32%
- Malpractice RVU0.76 · 9%
51
Medicare services in 2024 · #5345 by national volume
Compare 42900 by payment locality
Find the payment area for your service address, then open its rate page for calculation inputs, release history and the percentage-of-Medicare tool. A city may cross payment-area boundaries; the ZIP lookup above helps resolve the location.
1 of 1 payment localities
Wisconsin →
Office / nonfacility
Unavailable
Facility
$267.52
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How this local rate is calculated
Each RVU component is multiplied by its own geographic practice cost index (GPCI). The three adjusted components are added, then multiplied by the conversion factor. These are the inputs used for 42900 in Wisconsin.
PPRRVU2026_Oct_nonQPP.csv
5,095
- Code
- 42900
- Physician work
- 5.16
- Practice expense
- 2.73
- Malpractice
- 0.76
GPCI2026.csv
111
- Locality
- Wisconsin
- Physician work
- 1.000
- Practice expense
- 0.958
- Malpractice
- 0.308
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 5.16 | × 1.000 | 5.1600 |
| Practice expense | 2.73 | × 0.958 | 2.6153 |
| Malpractice | 0.76 | × 0.308 | 0.2341 |
| Total RVUs | 8.0094 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Wisconsin$267.52
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 5.16 | 1 |
| Practice expense | 2.73 | 0.958 |
| Malpractice | 0.76 | 0.308 |
(5.16 × 1 + 2.73 × 0.958 + 0.76 × 0.308) × $33.4009 = $267.52
The office and facility calculations use their respective practice-expense RVUs. The facility amount here is the physician fee, not a separate hospital or facility bill.
Where these rates come from
FeeBase calculates base physician payments from CMS work, practice-expense, and malpractice RVUs, adjusted by each locality’s geographic indices and the applicable conversion factor. Unavailable or separately priced services are labeled rather than assigned a made-up amount.
Source: RVU26D. Effective 2026-10-01 through the day before 2027-01-01.