CPT / HCPCS code · 2026 CMS data · Verified 2026-08-31
CPT 43220 RVU and Medicare Payment (2026)
Esophagoscopy balloon — 1.95 work RVU, about $957.94 non-facility Medicare payment at the 2026 conversion factor.
- Work RVU
- 1.95
- PE RVU (non-facility)
- 26.47
- PE RVU (facility)
- 0.96
- MP RVU
- 0.26
- Office payment
- $957.94
- Facility payment
- $105.88
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 43220 in a non-facility setting with national GPCI: (1.95 + 26.47 + 0.26) × $33.4009 ≈ $957.94. The same code in a facility setting pays about $105.88 because facility PE RVU (0.96) replaces office PE RVU.
What changes by locality
GPCI moves 43220 non-facility payment from $829.06 to $1,351.85 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 43220?
1.95. 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 43220 in 2026?
About $957.94 non-facility ($105.88 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 (1.95) and malpractice RVU stay fixed; only practice expense changes (26.47 office vs 0.96 facility). That is the entire office-vs-facility payment gap.