CPT code 43261: ERCP, biopsy2026 Medicare rate & RVUs in New Mexico
Reports ERCP with forceps tissue sampling of a biliary or pancreatic duct abnormality, such as a suspected lesion or stricture.
In New Mexico, Medicare pays $294.05 for 43261 in a facility. There’s no office rate.
Check a contract rate as a % of Medicare · 43261 nationwide
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
On this page 11 sections
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.
How New Mexico compares for 43261
Across 109 of 109 payment localities, the facility rate for 43261 runs from $274.48 in Arkansas to $390.49 in Alaska. New Mexico pays $294.05. The RVUs are the same everywhere; the geographic indexes change the dollars.
- New Mexico · this page$294.05
- Los Angeles, CA · California$309.62+$15.57
- Washington, DC area · District of Columbia$321.91+$27.86
- Miami, FL · Florida$332.80+$38.75
- Chicago, IL · Illinois$326.35+$32.30
- Manhattan, NY · New York$333.33+$39.28
- Alaska · Alaska$390.49+$96.44
Other areas in New Mexico first, then benchmark localities. Bars start at $0.
Every other payment area
| Payment locality | Office | Facility |
|---|---|---|
| AlabamaAlabama | — | $276.78 |
| ArkansasArkansas | — | $274.48 |
| ArizonaArizona | — | $290.12 |
| Bakersfield, CACalifornia | — | $297.65 |
| Chico, CACalifornia | — | $295.61 |
| El Centro, CACalifornia | — | $295.72 |
| Fresno, CACalifornia | — | $295.61 |
| Hanford, CACalifornia | — | $295.61 |
| Madera, CACalifornia | — | $295.61 |
| Merced, CACalifornia | — | $295.61 |
| Modesto, CACalifornia | — | $295.61 |
| Napa, CACalifornia | — | $320.37 |
| Oxnard, CACalifornia | — | $306.02 |
| Redding, CACalifornia | — | $295.61 |
| Rest of CaliforniaCalifornia | — | $295.61 |
| Riverside, CACalifornia | — | $302.91 |
| Sacramento, CACalifornia | — | $304.30 |
| Salinas, CACalifornia | — | $303.00 |
| San Diego, CACalifornia | — | $305.63 |
| Marin County, CACalifornia | — | $332.38 |
| San Francisco, CACalifornia | — | $331.62 |
| San Benito County, CACalifornia | — | $339.44 |
| Santa Clara County, CACalifornia | — | $336.33 |
| San Luis Obispo, CACalifornia | — | $298.74 |
| Santa Cruz, CACalifornia | — | $305.08 |
| Santa Maria, CACalifornia | — | $302.91 |
| Santa Rosa, CACalifornia | — | $307.83 |
| Stockton, CACalifornia | — | $295.61 |
| Vallejo, CACalifornia | — | $319.27 |
| Visalia, CACalifornia | — | $295.61 |
| Yuba City, CACalifornia | — | $295.61 |
| ColoradoColorado | — | $297.76 |
| ConnecticutConnecticut | — | $309.91 |
| DelawareDelaware | — | $293.47 |
| Fort Lauderdale, FLFlorida | — | $314.63 |
| Rest of FloridaFlorida | — | $303.65 |
| Atlanta, GAGeorgia | — | $301.86 |
| Rest of GeorgiaGeorgia | — | $292.03 |
| Hawaii, Guam, HIHawaii | — | $296.15 |
| IowaIowa | — | $275.91 |
| IdahoIdaho | — | $277.98 |
| East St. Louis, ILIllinois | — | $312.46 |
| Rest of IllinoisIllinois | — | $301.86 |
| Suburban Chicago, ILIllinois | — | $316.24 |
| IndianaIndiana | — | $278.78 |
| KansasKansas | — | $277.51 |
| KentuckyKentucky | — | $285.61 |
| New Orleans, LALouisiana | — | $294.35 |
| Rest of LouisianaLouisiana | — | $286.28 |
| Metropolitan Boston, MAMassachusetts | — | $315.48 |
| Rest of MassachusettsMassachusetts | — | $298.12 |
| Baltimore area, MDMaryland | — | $309.42 |
| Rest of MarylandMaryland | — | $296.64 |
| Rest of MaineMaine | — | $281.31 |
| Southern Maine, MEMaine | — | $286.68 |
| Detroit, MIMichigan | — | $308.40 |
| Rest of MichiganMichigan | — | $292.15 |
| MinnesotaMinnesota | — | $281.96 |
| Metropolitan Kansas City, MOMissouri | — | $290.64 |
| Metropolitan St. Louis, MOMissouri | — | $292.15 |
| Rest of MissouriMissouri | — | $284.97 |
| MississippiMississippi | — | $279.64 |
| MontanaMontana | — | $295.55 |
| North CarolinaNorth Carolina | — | $282.64 |
| North DakotaNorth Dakota | — | $282.31 |
| NebraskaNebraska | — | $276.07 |
| New HampshireNew Hampshire | — | $295.79 |
| Northern New JerseyNew Jersey | — | $321.40 |
| Rest of New JerseyNew Jersey | — | $312.48 |
| NevadaNevada | — | $291.93 |
| NYC suburbs and Long Island, NYNew York | — | $341.36 |
| Poughkeepsie and northern NYC suburbs, NYNew York | — | $316.23 |
| Queens, NYNew York | — | $331.57 |
| Rest of New YorkNew York | — | $285.31 |
| OhioOhio | — | $289.44 |
| OklahomaOklahoma | — | $282.82 |
| Portland, OROregon | — | $301.16 |
| Rest of OregonOregon | — | $288.66 |
| Metropolitan Philadelphia, PAPennsylvania | — | $306.51 |
| Rest of PennsylvaniaPennsylvania | — | $288.40 |
| Puerto RicoPuerto Rico | — | $296.06 |
| Rhode IslandRhode Island | — | $299.39 |
| South CarolinaSouth Carolina | — | $286.71 |
| South DakotaSouth Dakota | — | $280.74 |
| TennesseeTennessee | — | $278.61 |
| Austin, TXTexas | — | $297.67 |
| Beaumont, TXTexas | — | $287.46 |
| Brazoria, TXTexas | — | $291.62 |
| Dallas, TXTexas | — | $293.93 |
| Fort Worth, TXTexas | — | $293.50 |
| Galveston, TXTexas | — | $292.84 |
| Houston, TXTexas | — | $305.11 |
| Rest of TexasTexas | — | $289.71 |
| UtahUtah | — | $288.95 |
| VirginiaVirginia | — | $287.78 |
| Virgin Islands, VIUnited States Virgin Islands | — | $296.06 |
| VermontVermont | — | $283.81 |
| Rest of WashingtonWashington | — | $296.71 |
| King County, WAWashington | — | $318.05 |
| WisconsinWisconsin | — | $277.05 |
| West VirginiaWest Virginia | — | $295.70 |
| WyomingWyoming | — | $289.78 |
43261 rates by state
Office rate range in each state. Select a state to see its payment localities.
Explore a state
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
| State / territory | Office rate range | Localities |
|---|---|---|
| AK | No published base rate | 1 |
| AL | No published base rate | 1 |
| AR | No published base rate | 1 |
| AZ | No published base rate | 1 |
| CA | No published base rate | 29 |
| CO | No published base rate | 1 |
| CT | No published base rate | 1 |
| DC | No published base rate | 1 |
| DE | No published base rate | 1 |
| FL | No published base rate | 3 |
| GA | No published base rate | 2 |
| GU | No published base rate | 1 |
| HI | No published base rate | 1 |
| IA | No published base rate | 1 |
| ID | No published base rate | 1 |
| IL | No published base rate | 4 |
| IN | No published base rate | 1 |
| KS | No published base rate | 1 |
| KY | No published base rate | 1 |
| LA | No published base rate | 2 |
| MA | No published base rate | 2 |
| MD | No published base rate | 3 |
| ME | No published base rate | 2 |
| MI | No published base rate | 2 |
| MN | No published base rate | 1 |
| MO | No published base rate | 3 |
| MS | No published base rate | 1 |
| MT | No published base rate | 1 |
| NC | No published base rate | 1 |
| ND | No published base rate | 1 |
| NE | No published base rate | 1 |
| NH | No published base rate | 1 |
| NJ | No published base rate | 2 |
| NM | No published base rate | 1 |
| NV | No published base rate | 1 |
| NY | No published base rate | 5 |
| OH | No published base rate | 1 |
| OK | No published base rate | 1 |
| OR | No published base rate | 2 |
| PA | No published base rate | 2 |
| PR | No published base rate | 1 |
| RI | No published base rate | 1 |
| SC | No published base rate | 1 |
| SD | No published base rate | 1 |
| TN | No published base rate | 1 |
| TX | No published base rate | 8 |
| UT | No published base rate | 1 |
| VA | No published base rate | 2 |
| VI | No published base rate | 1 |
| VT | No published base rate | 1 |
| WA | No published base rate | 2 |
| WI | No published base rate | 1 |
| WV | No published base rate | 1 |
| WY | No published base rate | 1 |
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
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.
The exact New Mexico inputs and CMS source lines
PPRRVU2026_Oct_nonQPP.csv
5,189
- Code
- 43261
- Physician work
- 6.00
- Practice expense
- 2.18
- Malpractice
- 0.67
GPCI2026.csv
77
- Locality
- New Mexico
- Physician work
- 1.000
- Practice expense
- 0.917
- Malpractice
- 1.201
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 6.00 | × 1.000 | 6.0000 |
| Practice expense | 2.18 | × 0.917 | 1.9991 |
| Malpractice | 0.67 | × 1.201 | 0.8047 |
| Total RVUs | 8.8037 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, New Mexico$294.05
Facility: (6 × 1 + 2.18 × 0.917 + 0.67 × 1.201) × $33.4009 = $294.05
Payment rules and modifiers for 43261
The CMS indicators that decide how 43261 is paid alongside other services.
CMS payment indicators · 43261
ERCP, biopsy
| 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 | 3 | Endoscopy family rules apply. |
| 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
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%).
How 43261 has changed in New Mexico
43261 · Office / nonfacility
Rate unavailable
Effective 2026-10-01
A rate is unavailable in one of these releases, so a change cannot be calculated.
One bar per available release, ordered by effective date. Missing rates remain gaps. These comparisons hold the code, setting and locality identifiers constant; they do not isolate which policy or input caused a change.
What changed, release by release
| Effective from | Office | Facility | CMS release |
|---|---|---|---|
| 2026-10-01 | Not available in this setting | $294.05 | RVU26D |
| 2026-07-01 | Not available in this setting | $294.05 | RVU26C |
| 2026-04-01 | Not available in this setting | $294.05 | RVU26B |
| 2026-01-01 | Not available in this setting | $294.05 | RVU26A |
| 2025-10-01 | Not available in this setting | $317.28 | RVU25D |
| 2025-07-01 | Not available in this setting | $317.28 | RVU25C |
| 2025-04-01 | Not available in this setting | $317.28 | RVU25B |
| 2025-01-01 | Not available in this setting | $317.28 | RVU25A |
| 2024-10-01 | Not available in this setting | $326.68 | RVU24D |
| 2024-07-01 | Not available in this setting | $326.68 | RVU24C |
| 2024-04-01 | Not available in this setting | $326.68 | RVU24B |
| 2024-03-09 | Not available in this setting | $326.68 | RVU24AR |
| 2024-01-01 | Not available in this setting | $321.35 | RVU24A |
| 2023-10-01 | Not available in this setting | $329.85 | RVU23D |
| 2023-07-01 | Not available in this setting | $329.85 | RVU23C |
| 2023-04-01 | Not available in this setting | $329.85 | RVU23B |
| 2023-01-01 | Not available in this setting | $329.85 | RVU23A |
| 2022-10-01 | Not available in this setting | $335.06 | RVU22D |
| 2022-07-01 | Not available in this setting | $335.06 | RVU22C |
| 2022-04-01 | Not available in this setting | $335.06 | RVU22B |
| 2022-01-01 | Not available in this setting | $335.06 | RVU22A |
| 2021-10-01 | Not available in this setting | $336.08 | RVU21D |
| 2021-07-01 | Not available in this setting | $336.08 | RVU21C |
| 2021-04-01 | Not available in this setting | $336.08 | RVU21B |
| 2021-01-01 | Not available in this setting | $336.08 | RVU21A |
| 2020-10-01 | Not available in this setting | $347.15 | RVU20D |
| 2020-07-01 | Not available in this setting | $347.15 | RVU20C |
| 2020-04-01 | Not available in this setting | $347.15 | RVU20B |
| 2020-01-01 | Not available in this setting | $347.15 | RVU20A |
| 2019-10-01 | Not available in this setting | $355.94 | RVU19D |
| 2019-07-01 | Not available in this setting | $355.94 | RVU19C |
| 2019-04-01 | Not available in this setting | $355.94 | RVU19B |
| 2019-01-01 | Not available in this setting | $355.94 | RVU19A |
| 2018-10-01 | Not available in this setting | $357.21 | RVU18D |
| 2018-07-01 | Not available in this setting | $357.21 | RVU18C |
| 2018-04-01 | Not available in this setting | $357.21 | RVU18B |
| 2018-01-01 | Not available in this setting | $357.21 | RVU18AR1 |
| 2017-10-01 | Not available in this setting | $354.36 | RVU17D |
| 2017-07-01 | Not available in this setting | $354.36 | RVU17C |
| 2017-04-01 | Not available in this setting | $354.36 | RVU17B |
| 2017-01-01 | Not available in this setting | $354.36 | RVU17A |
| 2016-10-01 | Not available in this setting | $357.72 | RVU16D |
| 2016-07-01 | Not available in this setting | $357.72 | RVU16C |
| 2016-04-01 | Not available in this setting | $357.72 | RVU16B |
| 2016-01-01 | Not available in this setting | $357.72 | RVU16A |
| 2015-10-01 | Not available in this setting | $365.32 | RVU15D |
| 2015-07-01 | Not available in this setting | $365.32 | RVU15C |
| 2015-04-01 | Not available in this setting | $363.50 | RVU15B |
| 2015-01-01 | Not available in this setting | $363.50 | RVU15A |
| 2014-10-01 | Not available in this setting | $362.75 | RVU14D |
| 2014-07-01 | Not available in this setting | $362.75 | RVU14C |
| 2014-04-01 | Not available in this setting | $362.75 | RVU14B |
| 2014-01-01 | Not available in this setting | $362.75 | RVU14A |
| 2013-10-01 | Not available in this setting | $357.29 | RVU13D |
| 2013-07-01 | Not available in this setting | $357.29 | RVU13C |
| 2013-04-01 | Not available in this setting | $357.29 | RVU13B |
| 2013-01-01 | Not available in this setting | $357.29 | RVU13AR |
Where the New Mexico rate applies
New Mexico is a Medicare payment area, not a city. Our Census mapping connects it to 528 cities and communities in New Mexico. Some span more than one payment area; confirm with the service ZIP.
- Abeytas
- Abiquiu
- Acomita Lake
- Adelino
- Agua Fria
- Alamillo
- Alamo
- Alamogordo
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
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