CPT / HCPCS code · 2026 CMS data · Verified 2026-08-31
CPT 43239 RVU and Medicare Payment (2026)
Egd biopsy single/multiple — 2.33 work RVU, about $418.85 non-facility Medicare payment at the 2026 conversion factor.
- Work RVU
- 2.33
- PE RVU (non-facility)
- 9.94
- PE RVU (facility)
- 1.1
- MP RVU
- 0.27
- Office payment
- $418.85
- Facility payment
- $123.58
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 43239 in a non-facility setting with national GPCI: (2.33 + 9.94 + 0.27) × $33.4009 ≈ $418.85. The same code in a facility setting pays about $123.58 because facility PE RVU (1.1) replaces office PE RVU.
What changes by locality
GPCI moves 43239 non-facility payment from $367.66 to $569.97 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
Going deeper: in-depth CPT 43239 RVU guide.
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 43239?
2.33. 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 43239 in 2026?
About $418.85 non-facility ($123.58 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 (2.33) and malpractice RVU stay fixed; only practice expense changes (9.94 office vs 1.1 facility). That is the entire office-vs-facility payment gap.