CPT / HCPCS code · 2026 CMS data · Verified 2026-08-31
CPT 43520 RVU and Medicare Payment (2026)
Incision of pyloric muscle — 11.01 work RVU, about $681.04 non-facility Medicare payment at the 2026 conversion factor.
- Work RVU
- 11.01
- PE RVU (non-facility)
- 6.44
- PE RVU (facility)
- 6.44
- MP RVU
- 2.94
- Office payment
- $681.04
- Facility payment
- $681.04
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 43520 in a non-facility setting with national GPCI: (11.01 + 6.44 + 2.94) × $33.4009 ≈ $681.04. The same code in a facility setting pays about $681.04 because facility PE RVU (6.44) replaces office PE RVU.
What changes by locality
GPCI moves 43520 non-facility payment from $603.09 to $840.01 across CMS localities — from Arkansas 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 43520?
11.01. 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 43520 in 2026?
About $681.04 non-facility ($681.04 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 (11.01) and malpractice RVU stay fixed; only practice expense changes (6.44 office vs 6.44 facility). That is the entire office-vs-facility payment gap.