CPT / HCPCS code · 2026 CMS data · Verified 2026-08-31
CPT 43101 RVU and Medicare Payment (2026)
Excision of esophagus lesion — 16.64 work RVU, about $968.63 non-facility Medicare payment at the 2026 conversion factor.
- Work RVU
- 16.64
- PE RVU (non-facility)
- 8.17
- PE RVU (facility)
- 8.17
- MP RVU
- 4.19
- Office payment
- $968.63
- Facility payment
- $968.63
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 43101 in a non-facility setting with national GPCI: (16.64 + 8.17 + 4.19) × $33.4009 ≈ $968.63. The same code in a facility setting pays about $968.63 because facility PE RVU (8.17) replaces office PE RVU.
What changes by locality
GPCI moves 43101 non-facility payment from $860.32 to $1,201.42 across CMS localities — from Wisconsin 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 43101?
16.64. 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 43101 in 2026?
About $968.63 non-facility ($968.63 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 (16.64) and malpractice RVU stay fixed; only practice expense changes (8.17 office vs 8.17 facility). That is the entire office-vs-facility payment gap.