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CPT 43240 — Egd w/transmural drain cyst

CPT code 43240 (Egd w/transmural drain cyst) carries 6.97 work RVUs under the CMS 2026 Medicare Physician Fee Schedule. Total RVUs are 10.24 in a non-facility setting and 10.24 in a facility setting, which at the 2026 conversion factor of $33.40 works out to $342.03 and $342.03 respectively.

6.97
Work RVU
10.24
Total RVU (non-facility)
$342.03
Medicare, non-facility
$342.03
Medicare, facility
Calculate your total wRVUs →

RVU breakdown for CPT 43240

ComponentRVUsWhat it covers
Work RVU6.97Physician time, skill, effort, and stress.
Practice expense RVU (non-facility)2.48Office overhead, staff, supplies.
Practice expense RVU (facility)0.0Overhead when performed in a hospital.
Malpractice RVU0.79Professional liability cost.
Total RVU (non-facility)10.24Work + non-facility PE + malpractice.
Total RVU (facility)10.24Work + facility PE + malpractice.

How Medicare payment is calculated

Medicare multiplies total RVUs by the annual conversion factor. For CPT 43240 in 2026:

SettingTotal RVUConversion factorNational payment
Non-facility10.24$33.40$342.03
Facility10.24$33.40$342.03

These are national amounts. Actual payment is adjusted by the Geographic Practice Cost Index for your locality — check yours with the GPCI lookup.

Billing rules for CPT 43240

Global period
0-day global — no pre- or post-operative period included.
Multiple procedure reduction
Subject to the multiple-endoscopy payment rule.
Bilateral surgery
Bilateral adjustment does not apply.
Assistant surgeon
Not permitted.
Co-surgeon
Not permitted unless documentation supports medical necessity.
Team surgery
Not permitted unless documentation supports medical necessity.

Related codes

Codes in the same CMS family, with their work RVU values.

43231 · 2.73 wRVU43232 · 3.5 wRVU43233 · 3.97 wRVU43235 · 2.04 wRVU43236 · 2.33 wRVU43237 · 3.38 wRVU43238 · 4.06 wRVU43239 · 2.33 wRVU

Questions about CPT 43240

How many work RVUs is CPT 43240?

CPT 43240 is assigned 6.97 work RVUs in the CMS 2026 Medicare Physician Fee Schedule.

What does Medicare pay for CPT 43240?

At the 2026 national conversion factor of $33.40, CPT 43240 pays approximately $342.03 in a non-facility setting and $342.03 in a facility setting before geographic adjustment.

What is the global period for CPT 43240?

0-day global — no pre- or post-operative period included.

RVU values reflect the CMS 2026 Medicare Physician Fee Schedule (conversion factor $33.40). Payment figures are national and unadjusted for geography. Verify against the official fee schedule before using for billing.