CPT / HCPCS code · 2026 CMS data · Verified 2026-08-31
CPT 43020 RVU and Medicare Payment (2026)
Incision of esophagus — 8.02 work RVU, about $551.78 non-facility Medicare payment at the 2026 conversion factor.
- Work RVU
- 8.02
- PE RVU (non-facility)
- 6.36
- PE RVU (facility)
- 6.36
- MP RVU
- 2.14
- Office payment
- $551.78
- Facility payment
- $551.78
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 43020 in a non-facility setting with national GPCI: (8.02 + 6.36 + 2.14) × $33.4009 ≈ $551.78. The same code in a facility setting pays about $551.78 because facility PE RVU (6.36) replaces office PE RVU.
What changes by locality
GPCI moves 43020 non-facility payment from $487.16 to $670.33 across CMS localities — from Arkansas to Nyc Suburbs/long Island. 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 43020?
8.02. 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 43020 in 2026?
About $551.78 non-facility ($551.78 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 (8.02) and malpractice RVU stay fixed; only practice expense changes (6.36 office vs 6.36 facility). That is the entire office-vs-facility payment gap.