CPT / HCPCS code · 2026 CMS data · Verified 2026-08-31
CPT 43238 RVU and Medicare Payment (2026)
Egd us fine needle bx/aspir — 4.06 work RVU, about $204.41 non-facility Medicare payment at the 2026 conversion factor.
- Work RVU
- 4.06
- PE RVU (non-facility)
- 1.62
- PE RVU (facility)
- 1.62
- MP RVU
- 0.44
- Office payment
- $204.41
- Facility payment
- $204.41
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 43238 in a non-facility setting with national GPCI: (4.06 + 1.62 + 0.44) × $33.4009 ≈ $204.41. The same code in a facility setting pays about $204.41 because facility PE RVU (1.62) replaces office PE RVU.
What changes by locality
GPCI moves 43238 non-facility payment from $189.66 to $269.14 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 43238?
4.06. 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 43238 in 2026?
About $204.41 non-facility ($204.41 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 (4.06) and malpractice RVU stay fixed; only practice expense changes (1.62 office vs 1.62 facility). That is the entire office-vs-facility payment gap.