CPT / HCPCS code · 2026 CMS data · Verified 2026-08-31
CPT 43254 RVU and Medicare Payment (2026)
Egd endo mucosal resection — 4.75 work RVU, about $236.81 non-facility Medicare payment at the 2026 conversion factor.
- Work RVU
- 4.75
- PE RVU (non-facility)
- 1.81
- PE RVU (facility)
- 1.81
- MP RVU
- 0.53
- Office payment
- $236.81
- Facility payment
- $236.81
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 43254 in a non-facility setting with national GPCI: (4.75 + 1.81 + 0.53) × $33.4009 ≈ $236.81. The same code in a facility setting pays about $236.81 because facility PE RVU (1.81) replaces office PE RVU.
What changes by locality
GPCI moves 43254 non-facility payment from $219.7 to $312.12 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 43254?
4.75. 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 43254 in 2026?
About $236.81 non-facility ($236.81 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 (4.75) and malpractice RVU stay fixed; only practice expense changes (1.81 office vs 1.81 facility). That is the entire office-vs-facility payment gap.