CPT / HCPCS code · 2026 CMS data · Verified 2026-08-31
CPT 43213 RVU and Medicare Payment (2026)
Esophagoscopy retro balloon — 4.51 work RVU, about $1,254.2 non-facility Medicare payment at the 2026 conversion factor.
- Work RVU
- 4.51
- PE RVU (non-facility)
- 32.37
- PE RVU (facility)
- 1.57
- MP RVU
- 0.67
- Office payment
- $1,254.2
- Facility payment
- $225.46
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 43213 in a non-facility setting with national GPCI: (4.51 + 32.37 + 0.67) × $33.4009 ≈ $1,254.2. The same code in a facility setting pays about $225.46 because facility PE RVU (1.57) replaces office PE RVU.
What changes by locality
GPCI moves 43213 non-facility payment from $1,090.9 to $1,738.28 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 43213?
4.51. 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 43213 in 2026?
About $1,254.2 non-facility ($225.46 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 (4.51) and malpractice RVU stay fixed; only practice expense changes (32.37 office vs 1.57 facility). That is the entire office-vs-facility payment gap.