CPT / HCPCS code · 2026 CMS data · Verified 2026-08-31
CPT 43100 RVU and Medicare Payment (2026)
Excision of esophagus lesion — 9.42 work RVU, about $558.13 non-facility Medicare payment at the 2026 conversion factor.
- Work RVU
- 9.42
- PE RVU (non-facility)
- 5.93
- PE RVU (facility)
- 5.93
- MP RVU
- 1.36
- Office payment
- $558.13
- Facility payment
- $558.13
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 43100 in a non-facility setting with national GPCI: (9.42 + 5.93 + 1.36) × $33.4009 ≈ $558.13. The same code in a facility setting pays about $558.13 because facility PE RVU (5.93) replaces office PE RVU.
What changes by locality
GPCI moves 43100 non-facility payment from $508.17 to $707.93 across CMS localities — from Arkansas to Alaska. 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 43100?
9.42. 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 43100 in 2026?
About $558.13 non-facility ($558.13 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 (9.42) and malpractice RVU stay fixed; only practice expense changes (5.93 office vs 5.93 facility). That is the entire office-vs-facility payment gap.