CPT / HCPCS code · 2026 CMS data · Verified 2026-08-31
CPT 43351 RVU and Medicare Payment (2026)
Surgical opening esophagus — 21.5 work RVU, about $1,275.58 non-facility Medicare payment at the 2026 conversion factor.
- Work RVU
- 21.5
- PE RVU (non-facility)
- 11.28
- PE RVU (facility)
- 11.28
- MP RVU
- 5.41
- Office payment
- $1,275.58
- Facility payment
- $1,275.58
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 43351 in a non-facility setting with national GPCI: (21.5 + 11.28 + 5.41) × $33.4009 ≈ $1,275.58. The same code in a facility setting pays about $1,275.58 because facility PE RVU (11.28) replaces office PE RVU.
What changes by locality
GPCI moves 43351 non-facility payment from $1,134.17 to $1,578 across CMS localities — from Nebraska 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 43351?
21.5. 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 43351 in 2026?
About $1,275.58 non-facility ($1,275.58 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 (21.5) and malpractice RVU stay fixed; only practice expense changes (11.28 office vs 11.28 facility). That is the entire office-vs-facility payment gap.