CPT / HCPCS code · 2026 CMS data · Verified 2026-08-31
CPT 43250 RVU and Medicare Payment (2026)
Egd cautery tumor polyp — 2.9 work RVU, about $498.68 non-facility Medicare payment at the 2026 conversion factor.
- Work RVU
- 2.9
- PE RVU (non-facility)
- 11.61
- PE RVU (facility)
- 1.25
- MP RVU
- 0.42
- Office payment
- $498.68
- Facility payment
- $152.64
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 43250 in a non-facility setting with national GPCI: (2.9 + 11.61 + 0.42) × $33.4009 ≈ $498.68. The same code in a facility setting pays about $152.64 because facility PE RVU (1.25) replaces office PE RVU.
What changes by locality
GPCI moves 43250 non-facility payment from $437.19 to $674.22 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 43250?
2.9. 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 43250 in 2026?
About $498.68 non-facility ($152.64 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 (2.9) and malpractice RVU stay fixed; only practice expense changes (11.61 office vs 1.25 facility). That is the entire office-vs-facility payment gap.