CPT / HCPCS code · 2026 CMS data · Verified 2026-08-31
CPT 43312 RVU and Medicare Payment (2026)
Repair esophagus and fistula — 28.52 work RVU, about $1,478.66 non-facility Medicare payment at the 2026 conversion factor.
- Work RVU
- 28.52
- PE RVU (non-facility)
- 8.55
- PE RVU (facility)
- 8.55
- MP RVU
- 7.2
- Office payment
- $1,478.66
- Facility payment
- $1,478.66
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 43312 in a non-facility setting with national GPCI: (28.52 + 8.55 + 7.2) × $33.4009 ≈ $1,478.66. The same code in a facility setting pays about $1,478.66 because facility PE RVU (8.55) replaces office PE RVU.
What changes by locality
GPCI moves 43312 non-facility payment from $1,300.25 to $1,865.54 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 43312?
28.52. 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 43312 in 2026?
About $1,478.66 non-facility ($1,478.66 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 (28.52) and malpractice RVU stay fixed; only practice expense changes (8.55 office vs 8.55 facility). That is the entire office-vs-facility payment gap.