CPT / HCPCS code · 2026 CMS data · Verified 2026-08-31
CPT 43263 RVU and Medicare Payment (2026)
Ercp sphincter pressure meas — 6.34 work RVU, about $311.96 non-facility Medicare payment at the 2026 conversion factor.
- Work RVU
- 6.34
- PE RVU (non-facility)
- 2.3
- PE RVU (facility)
- 2.3
- MP RVU
- 0.7
- Office payment
- $311.96
- Facility payment
- $311.96
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 43263 in a non-facility setting with national GPCI: (6.34 + 2.3 + 0.7) × $33.4009 ≈ $311.96. The same code in a facility setting pays about $311.96 because facility PE RVU (2.3) replaces office PE RVU.
What changes by locality
GPCI moves 43263 non-facility payment from $289.79 to $412.34 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 43263?
6.34. 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 43263 in 2026?
About $311.96 non-facility ($311.96 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 (6.34) and malpractice RVU stay fixed; only practice expense changes (2.3 office vs 2.3 facility). That is the entire office-vs-facility payment gap.