CPT / HCPCS code · 2026 CMS data · Verified 2026-08-31
CPT 42953 RVU and Medicare Payment (2026)
Repair throat esophagus — 9.21 work RVU, about $894.14 non-facility Medicare payment at the 2026 conversion factor.
- Work RVU
- 9.21
- PE RVU (non-facility)
- 16.13
- PE RVU (facility)
- 16.13
- MP RVU
- 1.43
- Office payment
- $894.14
- Facility payment
- $894.14
How the payment is calculated
Total RVU is work plus practice expense plus malpractice, each adjusted by its GPCI factor, then multiplied by the conversion factor. For 42953 in a non-facility setting with national GPCI: (9.21 + 16.13 + 1.43) × $33.4009 ≈ $894.14. The same code in a facility setting pays about $894.14 because facility PE RVU (16.13) replaces office PE RVU.
What changes by locality
GPCI moves 42953 non-facility payment from $795.01 to $1,143.95 across CMS localities — from Arkansas to San Jose-sunnyvale-santa Clara (san Benito Cnty). Check your exact locality in the GPCI calculator rather than using a state average.
Related codes
Checking a different code or locality? Open the full RVU calculator to run any of the 7,790 CPT/HCPCS codes with your own GPCI factors.
Frequently asked questions
What is the 2026 work RVU for CPT 42953?
9.21. Work RVU measures physician time, skill, and intensity — it does not change by setting or locality. Total payment adds practice expense and malpractice RVUs plus the conversion factor.
How much does Medicare pay for CPT 42953 in 2026?
About $894.14 non-facility ($894.14 facility) at national GPCI with the 2026 $33.4009 conversion factor. Your locality GPCI moves the number — see the range above.
Does the work RVU change between office and facility?
No. Work RVU (9.21) and malpractice RVU stay fixed; only practice expense changes (16.13 office vs 16.13 facility). That is the entire office-vs-facility payment gap.