CPT code 43260: ERCP, brushing or washing2026 Medicare rate & RVUs in Missouri
Diagnostic ERCP with ductal brushing or washing is reported when the endoscopist collects specimens from the biliary or pancreatic ducts.
CMS doesn’t publish an office rate for 43260 in Missouri.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
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What 43260 covers
A gastroenterologist advances an endoscope through the mouth to the duodenum, accesses the biliary or pancreatic ducts, and uses contrast imaging to evaluate ductal anatomy. This service includes collecting duct specimens by brushing or washing when performed. It may be used to investigate a suspected ductal stricture, obstruction, or other abnormality, often in a hospital or ambulatory endoscopy facility.
Report 43260 when the documented ERCP includes brushing or washing for specimen collection; forceps tissue sampling is distinguished by 43261. Documentation should identify the duct examined, the collection method, and the findings. The 0-day global period includes same-day preoperative and postoperative care. For multiple procedures in one session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% reduction. Modifier 50 is inappropriate for this service. Medicare does not pay an assistant at surgery; co-surgeons and team surgery are not permitted.
This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.
Where 43260 pays more and less in Missouri
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
| Payment locality | Office | Facility |
|---|---|---|
| Metropolitan Kansas City, MO | Unavailable | $276.17 |
| Metropolitan St. Louis, MO | Unavailable | $277.59 |
| Rest of Missouri | Unavailable | $270.73 |
How the 43260 rate is calculated
Each of 43260’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.
How the rate is built · 43260
RVUs × geographic indexes × conversion factor
Work5.70
5.70 RVUs× 1.000 GPCI
Practice expense2.09
2.09 RVUs× 1.000 GPCI
Malpractice0.62
0.62 RVUs× 1.000 GPCI
Adjusted RVUs
8.4100
Conversion factor
$33.4009
Medicare rate
$280.90
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 43260
The CMS indicators that decide how 43260 is paid alongside other services.
CMS payment indicators · 43260
ERCP, brushing or washing
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 000 | Same-day global: pre- and post-op care on the day of the procedure is included. |
| Multiple procedures | 2 | Standard reduction: highest-valued procedure at 100%, others at 50%. |
| Bilateral (modifier 50) | 0 | The 150% bilateral adjustment doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 1 | Not paid (statutory restriction). |
| Co-surgeons (62) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
What modifiers do to the payment
Modifier 51 · payment effect
With and without the modifier
43260 without 51 · national facility
$280.90
ERCP, brushing or washing
43260-51 · Second procedure: 50%
$140.45
When this isn’t the highest-valued procedure in the session, Medicare pays 50% of its fee schedule amount (the highest is paid at 100%).
43260 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 43261ERCPBiopsy
- 43260 covers duct specimen collection by brushing or washing. Choose 43261 for tissue sampling by biopsy.
- 43262ERCP sphincterotomyPapillotomy performed
- 43262 describes ERCP with sphincterotomy or papillotomy, a duct-opening intervention rather than specimen collection.
- 43264ERCP extractionDuct stones or debris
- 43264 is for ERCP with duct calculus removal; 43260 describes diagnostic duct evaluation with brushing or washing.
- 43274ERCP stentingBiliary or pancreatic duct
- 43274 describes ERCP with duct stent placement. A stent procedure is distinct from the specimen-collection service in 43260.
43260 billing questions
When should 43260 be chosen instead of 43261?
Use 43260 for ERCP with ductal specimen collection by brushing or washing. Use 43261 when the endoscopist takes tissue by biopsy.
Is brushing or washing separately reported?
The ductal brushing or washing specimen collection is included in 43260. The operative report should state the collection method and site.
Can 43260 be reported with an ERCP treatment code?
Code the ERCP services actually performed and documented, including therapeutic work when supported. When multiple procedures occur in the same session, CMS applies the multiple-procedure reduction to the lower-valued procedures.
Should modifier 50 be appended?
No. Modifier 50 is inappropriate for this ERCP service.
Can an assistant or co-surgeon be paid for 43260?
Medicare does not pay an assistant at surgery for this service, and co-surgeons and team surgery are not permitted.
Where these rates come from
FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.
CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027
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