CPT / HCPCS code · 2026 CMS data · Verified 2026-08-31
CPT 43264 RVU and Medicare Payment (2026)
Ercp remove duct calculi — 6.46 work RVU, about $317.31 non-facility Medicare payment at the 2026 conversion factor.
- Work RVU
- 6.46
- PE RVU (non-facility)
- 2.32
- PE RVU (facility)
- 2.32
- MP RVU
- 0.72
- Office payment
- $317.31
- Facility payment
- $317.31
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 43264 in a non-facility setting with national GPCI: (6.46 + 2.32 + 0.72) × $33.4009 ≈ $317.31. The same code in a facility setting pays about $317.31 because facility PE RVU (2.32) replaces office PE RVU.
What changes by locality
GPCI moves 43264 non-facility payment from $294.72 to $419.43 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 43264?
6.46. 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 43264 in 2026?
About $317.31 non-facility ($317.31 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 (6.46) and malpractice RVU stay fixed; only practice expense changes (2.32 office vs 2.32 facility). That is the entire office-vs-facility payment gap.