CPT / HCPCS code · 2026 CMS data · Verified 2026-08-31
CPT 43313 RVU and Medicare Payment (2026)
Esophagoplasty congenital — 47.24 work RVU, about $2,709.15 non-facility Medicare payment at the 2026 conversion factor.
- Work RVU
- 47.24
- PE RVU (non-facility)
- 21.21
- PE RVU (facility)
- 21.21
- MP RVU
- 12.66
- Office payment
- $2,709.15
- Facility payment
- $2,709.15
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 43313 in a non-facility setting with national GPCI: (47.24 + 21.21 + 12.66) × $33.4009 ≈ $2,709.15. The same code in a facility setting pays about $2,709.15 because facility PE RVU (21.21) replaces office PE RVU.
What changes by locality
GPCI moves 43313 non-facility payment from $2,386.78 to $3,384.74 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 43313?
47.24. 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 43313 in 2026?
About $2,709.15 non-facility ($2,709.15 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 (47.24) and malpractice RVU stay fixed; only practice expense changes (21.21 office vs 21.21 facility). That is the entire office-vs-facility payment gap.