CPT / HCPCS code · 2026 CMS data · Verified 2026-08-31
CPT 43201 RVU and Medicare Payment (2026)
Esoph scope w/submucous inj — 1.68 work RVU, about $278.23 non-facility Medicare payment at the 2026 conversion factor.
- Work RVU
- 1.68
- PE RVU (non-facility)
- 6.43
- PE RVU (facility)
- 0.86
- MP RVU
- 0.22
- Office payment
- $278.23
- Facility payment
- $92.19
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 43201 in a non-facility setting with national GPCI: (1.68 + 6.43 + 0.22) × $33.4009 ≈ $278.23. The same code in a facility setting pays about $92.19 because facility PE RVU (0.86) replaces office PE RVU.
What changes by locality
GPCI moves 43201 non-facility payment from $244.38 to $375.92 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 43201?
1.68. 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 43201 in 2026?
About $278.23 non-facility ($92.19 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 (1.68) and malpractice RVU stay fixed; only practice expense changes (6.43 office vs 0.86 facility). That is the entire office-vs-facility payment gap.