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CPT code 43261: ERCP, biopsy2026 Medicare rate & RVUs

Reports ERCP with forceps tissue sampling of a biliary or pancreatic duct abnormality, such as a suspected lesion or stricture.

CMS RVU26DEffective Oct 1, 2026109 payment localities6.3K Medicare services in 2024

Medicare pays $295.60 for 43261 nationally in a facility.

Medicare rate · 43261

ERCP, biopsy

Office or facility?

Work RVUs
6
Total RVUs
8.85
Global days
000

National rate · 2026

$295.60

Facility setting, before claim adjustments.

See every locality for 43261 →Billed by an NP, PA or therapist? →

Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.

Your location

Medicare pays by the payment locality where the service is performed.

On this page 10 sections
  1. Medicare rate
  2. What 43261 covers
  3. By payment locality
  4. Rate map
  5. How it’s calculated
  6. Payment rules
  7. Similar codes
  8. Related codes
  9. Billing questions
  10. Sources

What 43261 covers

During ERCP, a gastroenterologist advances a side-viewing endoscope through the mouth to the duodenum, accesses the biliary or pancreatic duct, and obtains one or more tissue samples. The service is used to investigate a ductal abnormality, including a suspected tumor or stricture. ERCP is typically performed in a hospital or ambulatory surgery center, often with fluoroscopic guidance.

Report this code when the ERCP includes biopsy; brushing or washing for specimens alone is a different service. The procedure report should identify the sampled site and document the tissue-sampling work. CMS assigns a 0-day global period, so same-day preoperative and postoperative care is included. When related endoscopies are performed together, endoscopy-family pricing applies. Modifier 50 is inappropriate for this service. Medicare does not pay an assistant at surgery, and co-surgeon and team-surgery billing 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 43261 pays more and less

The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.

109 of 109 payment localities

43261 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$276.78
AlaskaUnavailable$390.49
ArizonaUnavailable$290.12
ArkansasUnavailable$274.48
Atlanta, GAUnavailable$301.86
Austin, TXUnavailable$297.67
Bakersfield, CAUnavailable$297.65
Baltimore area, MDUnavailable$309.42
Beaumont, TXUnavailable$287.46
Brazoria, TXUnavailable$291.62

43261 rates by state

Office rate range in each state. Select a state to see its payment localities.

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Local rates. Clear comparisons.

Hover or focus a tile to see its rate range. Select it to open the state’s fee schedule.

View every state and territory as a table
43261 office rate range by state
State / territoryOffice rate rangeLocalities
AKNo published base rate1
ALNo published base rate1
ARNo published base rate1
AZNo published base rate1
CANo published base rate29
CONo published base rate1
CTNo published base rate1
DCNo published base rate1
DENo published base rate1
FLNo published base rate3
GANo published base rate2
GUNo published base rate1
HINo published base rate1
IANo published base rate1
IDNo published base rate1
ILNo published base rate4
INNo published base rate1
KSNo published base rate1
KYNo published base rate1
LANo published base rate2
MANo published base rate2
MDNo published base rate3
MENo published base rate2
MINo published base rate2
MNNo published base rate1
MONo published base rate3
MSNo published base rate1
MTNo published base rate1
NCNo published base rate1
NDNo published base rate1
NENo published base rate1
NHNo published base rate1
NJNo published base rate2
NMNo published base rate1
NVNo published base rate1
NYNo published base rate5
OHNo published base rate1
OKNo published base rate1
ORNo published base rate2
PANo published base rate2
PRNo published base rate1
RINo published base rate1
SCNo published base rate1
SDNo published base rate1
TNNo published base rate1
TXNo published base rate8
UTNo published base rate1
VANo published base rate2
VINo published base rate1
VTNo published base rate1
WANo published base rate2
WINo published base rate1
WVNo published base rate1
WYNo published base rate1

How the 43261 rate is calculated

Each of 43261’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 · 43261

RVUs × geographic indexes × conversion factor

Office or facility?

Work6.00

6.00 RVUs× 1.000 GPCI

Practice expense2.18

2.18 RVUs× 1.000 GPCI

Malpractice0.67

0.67 RVUs× 1.000 GPCI

Adjusted RVUs

8.8500

Conversion factor

$33.4009

Medicare rate

$295.60

Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.

Payment rules and modifiers for 43261

The CMS indicators that decide how 43261 is paid alongside other services.

CMS payment indicators · 43261

ERCP, biopsy

RuleCMS valueWhat it means
Global period000Same-day global: pre- and post-op care on the day of the procedure is included.
Multiple procedures3Endoscopy family rules apply.
Bilateral (modifier 50)0The 150% bilateral adjustment doesn’t apply.
Assistant at surgery (80/81/82/AS)1Not paid (statutory restriction).
Co-surgeons (62)0Not permitted.
Team surgery (66)0Not permitted.
Professional/technical0Physician service: no professional/technical split.

What modifiers do to the payment

Modifier 51 · payment effect

With and without the modifier

43261 without 51 · national facility

$295.60

ERCP, biopsy

43261-51 · Second procedure: 50%

$147.80

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%).

When to use modifier 51

43261 compared with similar codes

Compare codes · National

5 codes, side by side

Office or facility?

  • 43261

    ERCP, biopsy6 wRVU

    Not priced

  • 43260

    ERCP, brushing or washing5.7 wRVU

    Not priced

  • 43262

    ERCP sphincterotomy, papillotomy performed6.34 wRVU

    Not priced

  • 43264

    ERCP extraction, duct stones or debris6.46 wRVU

    Not priced

  • 43274

    ERCP stenting, biliary or pancreatic duct8.27 wRVU

    Not priced

How to choose

43260ERCPBrushing or washing
Choose 43261 for tissue biopsy. Choose 43260 when ERCP specimen collection is by brushing or washing.
43262ERCP sphincterotomyPapillotomy performed
43262 represents ERCP with sphincterotomy. Biopsy sampling, rather than sphincterotomy, distinguishes 43261.
43264ERCP extractionDuct stones or debris
43264 represents ERCP removal of duct calculi. It is selected for stone extraction, not duct tissue biopsy.
43274ERCP stentingBiliary or pancreatic duct
43274 represents ERCP duct stent placement. Use 43261 for biopsy; stent placement is a different intervention.

Codes related to 43261

Related codes aren’t interchangeable: bill the code that matches the service performed.

Codes related to 43261
CodeHow it relatesNational office range
Used instead
43260ERCP, brushing or washingERCP specimen collection by brushing or washing, rather than tissue biopsy.No office rate
Often billed with
43262ERCP sphincterotomy, papillotomy performedSphincterotomy may be performed during the same ERCP when separately documented.No office rate
43274ERCP stenting, biliary or pancreatic ductDuct stent placement may accompany ERCP biopsy for an obstructing abnormality.No office rate

43261 billing questions

How is this different from 43260?

Use 43261 when ERCP includes tissue biopsy. Code 43260 describes ERCP with specimen collection by brushing or washing rather than biopsy.

Can brushing or washing be reported with the biopsy?

The biopsy code identifies the tissue-sampling ERCP service. Document each method performed and apply applicable coding edits and endoscopy-family pricing when related endoscopies are reported together.

Does modifier 50 apply if both sides of the biliary system are sampled?

No. CMS identifies bilateral adjustment as inapplicable to this code, and modifier 50 is inappropriate.

Can an assistant surgeon or co-surgeon be billed?

Medicare does not pay an assistant at surgery for this code. Co-surgeons and team surgery are not permitted.

What documentation supports reporting 43261?

The ERCP report should describe the ductal abnormality, the site sampled, and the biopsy performed. It should distinguish tissue biopsy from brushing or washing alone.

Does the code include same-day postoperative care?

Yes. The code has a 0-day global period, which includes same-day preoperative and postoperative care.

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

Show the CMS file lines behind this rate
RVUs for 43261PPRRVU2026_Oct_nonQPP.csv, line 5,189 (RVU26D)

Open CMS sourceHow we calculate rates

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