Locality

or ZIP

Show values as

Switch every figure between Medicare dollars and work RVUs.

Conversion factor

99242

Off/op consltj new/est sf 20

Add to my model

Code typePrimary

Payment statusNot valid for Medicare (I)

Global periodNone

Not valid for Medicare: Medicare uses a different code to report and pay for this service.

Pricing with Related Codes

Line

Qty

Global fee

Pro fee

Primary99242Off/op consltj new/est sf 20

$0.00

Add-on90833Psytx w pt w e/m 30 min

$81.50/ unit

$65.80/ unit

Add-on90836Psytx w pt w e/m 45 min

$103.21/ unit

$83.17/ unit

Add-on90838Psytx w pt w e/m 60 min

$136.61/ unit

$110.22/ unit

Add-on96160Pt-focused hlth risk assmt

$3.01/ unit

Add-on96161Caregiver health risk assmt

$3.34/ unit

Add-on99459Pelvic examination

$17.37/ unit

Whole procedure · 0.00 wRVU credited

$0.00

How these numbers were computed

status=IThis code is not separately payable under the Physician Fee Schedule (status I) — amounts shown are $0.

RVU Breakdown

Component

Office

Facility

Work

1.08

Practice expense

1.10

0.51

Malpractice

0.07

Total RVU

2.25

1.66

Payment Policy & Modifiers

Allowed adjustments

No payment adjustments apply to this code.

Not applicable to this code

Bilateral -50Multiple procedure Assistant surgeon Co-surgeon -62Team surgeon -66Prof / tech split

In plain English

Office vs. facility

Where the service happens. In your own clinic (office), Medicare also pays you for the room, staff and supplies — so it's higher. In a hospital or ASC, the facility bills that part separately.

wRVU

Work Relative Value Units — the physician-effort share of a code. Most employment contracts pay a set dollar amount per wRVU, independent of Medicare's rate.

Add-on codes

Billed only alongside a primary. 90833 adds each extra unit — the stepper adds them to the whole-procedure total.

Conversion factor

The dollars-per-RVU Medicare multiplies by. Set once, it flows through every figure on this page. The QP rate applies to clinicians who qualify as Advanced APM participants — a small annual boost.

GPCI

Geographic Practice Cost Index — adjusts the work, practice-expense and malpractice RVUs for your locality's cost of living before they're multiplied by the conversion factor.

How payment is computed

Each RVU is scaled by your locality's GPCI, summed, then multiplied by the conversion factor:

(work·wGPCI
+ PE·peGPCI
+ MP·mpGPCI) × CF

This code's Global fee

(1.08·1.000
+ 1.10·1.000
+ 0.07·1.000) × $33.40 = $75.15

This line's global fee is $0.00 — the formula above, after:

status=I

Full methodology — how we apply CMS's rules →