CPT / HCPCS code · 2026 CMS data · Verified 2026-08-31
CPT 43286 RVU and Medicare Payment (2026)
Esphg tot w/laps moblj — 53.63 work RVU, about $2,945.29 non-facility Medicare payment at the 2026 conversion factor.
- Work RVU
- 53.63
- PE RVU (non-facility)
- 20.84
- PE RVU (facility)
- 20.84
- MP RVU
- 13.71
- Office payment
- $2,945.29
- Facility payment
- $2,945.29
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 43286 in a non-facility setting with national GPCI: (53.63 + 20.84 + 13.71) × $33.4009 ≈ $2,945.29. The same code in a facility setting pays about $2,945.29 because facility PE RVU (20.84) replaces office PE RVU.
What changes by locality
GPCI moves 43286 non-facility payment from $2,599.17 to $3,680.57 across CMS localities — from Wisconsin 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 43286?
53.63. 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 43286 in 2026?
About $2,945.29 non-facility ($2,945.29 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 (53.63) and malpractice RVU stay fixed; only practice expense changes (20.84 office vs 20.84 facility). That is the entire office-vs-facility payment gap.