CPT / HCPCS code · 2026 CMS data · Verified 2026-08-31
CPT 43281 RVU and Medicare Payment (2026)
Lap paraesophag hern repair — 25.94 work RVU, about $1,424.88 non-facility Medicare payment at the 2026 conversion factor.
- Work RVU
- 25.94
- PE RVU (non-facility)
- 9.97
- PE RVU (facility)
- 9.97
- MP RVU
- 6.75
- Office payment
- $1,424.88
- Facility payment
- $1,424.88
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 43281 in a non-facility setting with national GPCI: (25.94 + 9.97 + 6.75) × $33.4009 ≈ $1,424.88. The same code in a facility setting pays about $1,424.88 because facility PE RVU (9.97) replaces office PE RVU.
What changes by locality
GPCI moves 43281 non-facility payment from $1,254.88 to $1,783.26 across CMS localities — from Wisconsin to Miami. 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 43281?
25.94. 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 43281 in 2026?
About $1,424.88 non-facility ($1,424.88 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 (25.94) and malpractice RVU stay fixed; only practice expense changes (9.97 office vs 9.97 facility). That is the entire office-vs-facility payment gap.