CPT / HCPCS code · 2026 CMS data · Verified 2026-08-31
CPT 43240 RVU and Medicare Payment (2026)
Egd w/transmural drain cyst — 6.97 work RVU, about $342.03 non-facility Medicare payment at the 2026 conversion factor.
- Work RVU
- 6.97
- PE RVU (non-facility)
- 2.48
- PE RVU (facility)
- 2.48
- MP RVU
- 0.79
- Office payment
- $342.03
- Facility payment
- $342.03
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 43240 in a non-facility setting with national GPCI: (6.97 + 2.48 + 0.79) × $33.4009 ≈ $342.03. The same code in a facility setting pays about $342.03 because facility PE RVU (2.48) replaces office PE RVU.
What changes by locality
GPCI moves 43240 non-facility payment from $317.55 to $451.96 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 43240?
6.97. 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 43240 in 2026?
About $342.03 non-facility ($342.03 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 (6.97) and malpractice RVU stay fixed; only practice expense changes (2.48 office vs 2.48 facility). That is the entire office-vs-facility payment gap.