CPT code 43262: ERCP sphincterotomy, papillotomy performed2026 Medicare rate & RVUs in Montana

In Montana, Medicare pays $311.25 for 43262 in a facility. There’s no office rate.

Check a contract rate as a % of Medicare · 43262 nationwide

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

What 43262 covers

During ERCP, a gastroenterologist advances an endoscope to the major papilla and uses an endoscopic cutting instrument to incise the biliary or pancreatic sphincter. The opening can facilitate duct drainage or allow treatment such as removing common bile duct stones. This service is generally performed in a hospital or ambulatory endoscopy setting when imaging or other evaluation indicates a need for therapeutic duct access, including biliary obstruction or choledocholithiasis.

Report this code when the procedure record supports that a sphincterotomy or papillotomy was actually performed, not merely planned or considered. Document the indication, the site of the incision, and the therapeutic work completed. The code has a 0-day global period, so same-day preoperative and postoperative care is included. When related endoscopies are performed together, CMS endoscopy family pricing applies. Modifier 50 is inappropriate; an assistant at surgery is not paid under the statutory restriction, and co-surgeon and team-surgery payment 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 Montana compares for 43262

Across 109 of 109 payment localities, the facility rate for 43262 runs from $289.22 in Arkansas to $411.63 in Alaska. Montana pays $311.25. The RVUs are the same everywhere; the geographic indexes change the dollars.

Every other payment area

43262 rates by state

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

See 43262 in every payment locality

How the 43262 rate is calculated

Each of 43262’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.

Payment rules and modifiers for 43262

The CMS indicators that decide how 43262 is paid alongside other services.

What modifiers do to the payment

When to use modifier 51

Codes related to 43262

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

How 43262 has changed in Montana

Price 43262 for an earlier date of service

Where the Montana rate applies

Montana is a Medicare payment area, not a city. Our Census mapping connects it to 497 cities and communities in Montana. Some span more than one payment area; confirm with the service ZIP.

• Absarokee
• Acton
• Alberton
• Alder
• Alzada
• Amsterdam
• Anaconda-Deer Lodge County
• Antelope

Browse all communities in Montana

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

Open CMS sourceHow we calculate rates