CPT / HCPCS code · 2026 CMS data · Verified 2026-08-31
CPT 43278 RVU and Medicare Payment (2026)
Ercp lesion ablate w/dilate — 7.72 work RVU, about $376.43 non-facility Medicare payment at the 2026 conversion factor.
- Work RVU
- 7.72
- PE RVU (non-facility)
- 2.68
- PE RVU (facility)
- 2.68
- MP RVU
- 0.87
- Office payment
- $376.43
- Facility payment
- $376.43
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 43278 in a non-facility setting with national GPCI: (7.72 + 2.68 + 0.87) × $33.4009 ≈ $376.43. The same code in a facility setting pays about $376.43 because facility PE RVU (2.68) replaces office PE RVU.
What changes by locality
GPCI moves 43278 non-facility payment from $349.71 to $498.13 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 43278?
7.72. 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 43278 in 2026?
About $376.43 non-facility ($376.43 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 (7.72) and malpractice RVU stay fixed; only practice expense changes (2.68 office vs 2.68 facility). That is the entire office-vs-facility payment gap.