CPT / HCPCS code · 2026 CMS data · Verified 2026-08-31
CPT 43605 RVU and Medicare Payment (2026)
Biopsy of stomach — 13.38 work RVU, about $800.62 non-facility Medicare payment at the 2026 conversion factor.
- Work RVU
- 13.38
- PE RVU (non-facility)
- 7.01
- PE RVU (facility)
- 7.01
- MP RVU
- 3.58
- Office payment
- $800.62
- Facility payment
- $800.62
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 43605 in a non-facility setting with national GPCI: (13.38 + 7.01 + 3.58) × $33.4009 ≈ $800.62. The same code in a facility setting pays about $800.62 because facility PE RVU (7.01) replaces office PE RVU.
What changes by locality
GPCI moves 43605 non-facility payment from $708.04 to $993.05 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 43605?
13.38. 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 43605 in 2026?
About $800.62 non-facility ($800.62 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 (13.38) and malpractice RVU stay fixed; only practice expense changes (7.01 office vs 7.01 facility). That is the entire office-vs-facility payment gap.