CPT / HCPCS code · 2026 CMS data · Verified 2026-08-31
CPT 43415 RVU and Medicare Payment (2026)
Repair esophagus wound — 43.76 work RVU, about $2,414.55 non-facility Medicare payment at the 2026 conversion factor.
- Work RVU
- 43.76
- PE RVU (non-facility)
- 17.52
- PE RVU (facility)
- 17.52
- MP RVU
- 11.01
- Office payment
- $2,414.55
- Facility payment
- $2,414.55
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 43415 in a non-facility setting with national GPCI: (43.76 + 17.52 + 11.01) × $33.4009 ≈ $2,414.55. The same code in a facility setting pays about $2,414.55 because facility PE RVU (17.52) replaces office PE RVU.
What changes by locality
GPCI moves 43415 non-facility payment from $2,135.49 to $3,018.28 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 43415?
43.76. 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 43415 in 2026?
About $2,414.55 non-facility ($2,414.55 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 (43.76) and malpractice RVU stay fixed; only practice expense changes (17.52 office vs 17.52 facility). That is the entire office-vs-facility payment gap.