CPT / HCPCS code · 2026 CMS data · Verified 2026-08-31
CPT 43831 RVU and Medicare Payment (2026)
Gastrostomy open neonatal — 8.28 work RVU, about $598.88 non-facility Medicare payment at the 2026 conversion factor.
- Work RVU
- 8.28
- PE RVU (non-facility)
- 7.45
- PE RVU (facility)
- 7.45
- MP RVU
- 2.2
- Office payment
- $598.88
- Facility payment
- $598.88
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 43831 in a non-facility setting with national GPCI: (8.28 + 7.45 + 2.2) × $33.4009 ≈ $598.88. The same code in a facility setting pays about $598.88 because facility PE RVU (7.45) replaces office PE RVU.
What changes by locality
GPCI moves 43831 non-facility payment from $528.15 to $726.58 across CMS localities — from Arkansas to Nyc Suburbs/long Island. 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 43831?
8.28. 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 43831 in 2026?
About $598.88 non-facility ($598.88 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 (8.28) and malpractice RVU stay fixed; only practice expense changes (7.45 office vs 7.45 facility). That is the entire office-vs-facility payment gap.