CPT 12042 Surgery - Integumentary
Intmd rpr n-hf/genit2.6-7.5 Cost
Body System: Integumentary
Medicare Facility Rate
$168
CMS PFS CY2026
Medicare Non-Facility Rate
$305
Office/clinic setting
Hospital Outpatient
$415
OPPS rate
Surgery Center (ASC)
$205
ASC rate
Relative Value Units (RVUs)
Medicare payment = Total RVU × Conversion Factor ($33.40 for CY 2026)
2.72
Work RVU
2.02
Facility PE RVU
0.30
Malpractice RVU
9.13
Total RVU
Frequently Asked Questions
How much does Intmd rpr n-hf/genit2.6-7.5 cost?
The Medicare facility rate is $168. Commercial insurance typically pays 150-250% of Medicare rates (varies). Hospital outpatient rate: $415. Ambulatory surgery center rate: $205.
How much does Intmd rpr n-hf/genit2.6-7.5 cost without insurance?
Without insurance, you may pay the hospital's chargemaster rate, which is often 300-500% of Medicare. Ask about cash-pay discounts — many facilities offer 20-40% off for self-pay patients. The Medicare baseline for this procedure is $168.