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CPT code 43263: ERCP manometry, sphincter of Oddi pressure2026 Medicare rate & RVUs

Report this service when an endoscopist performs sphincter of Oddi pressure measurements during ERCP to evaluate suspected biliary or pancreatic outflow dysfunction.

CMS RVU26DEffective Oct 1, 2026109 payment localities19 Medicare services in 2024

Medicare pays $311.96 for 43263 nationally in a facility.

Medicare rate · 43263

ERCP manometry, sphincter of Oddi pressure

Office or facility?

Work RVUs
6.34
Total RVUs
9.34
Global days
000

National rate · 2026

$311.96

Facility setting, before claim adjustments.

See every locality for 43263 →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 43263 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 43263 covers

During ERCP, the endoscopist uses a manometry catheter to measure pressure at the sphincter of Oddi, which regulates bile and pancreatic juice flow into the duodenum. Gastroenterologists typically perform the study in a hospital or ambulatory endoscopy setting, often when evaluating suspected sphincter-related outflow problems. The service involves actual pressure measurement; ERCP imaging or cannulation alone does not support reporting it.

Select this code when the procedure record documents sphincter pressure measurements, the anatomy assessed, and relevant findings. The ERCP access and pressure study are represented together, so do not separately report a diagnostic ERCP code for the same service. CMS assigns a 0-day global period, including same-day preoperative and postoperative care. When related endoscopies are performed together, CMS applies endoscopy-family pricing. Modifier 50 is inappropriate for this code. Medicare does not pay an assistant at surgery, and 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 43263 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

43263 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$292.21
AlaskaUnavailable$412.34
ArizonaUnavailable$306.22
ArkansasUnavailable$289.79
Atlanta, GAUnavailable$318.53
Austin, TXUnavailable$314.18
Bakersfield, CAUnavailable$314.22
Baltimore area, MDUnavailable$326.50
Beaumont, TXUnavailable$303.39
Brazoria, TXUnavailable$307.82

43263 rates by state

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

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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
43263 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 43263 rate is calculated

Each of 43263’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 · 43263

RVUs × geographic indexes × conversion factor

Office or facility?

Work6.34

6.34 RVUs× 1.000 GPCI

Practice expense2.30

2.30 RVUs× 1.000 GPCI

Malpractice0.70

0.70 RVUs× 1.000 GPCI

Adjusted RVUs

9.3400

Conversion factor

$33.4009

Medicare rate

$311.96

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

Payment rules and modifiers for 43263

The CMS indicators that decide how 43263 is paid alongside other services.

CMS payment indicators · 43263

ERCP manometry, sphincter of Oddi pressure

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

43263 without 51 · national facility

$311.96

ERCP manometry, sphincter of Oddi pressure

43263-51 · Second procedure: 50%

$155.98

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

43263 compared with similar codes

Compare codes · National

4 codes, side by side

Office or facility?

  • 43263

    ERCP manometry, sphincter of Oddi pressure6.34 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

How to choose

43260ERCPBrushing or washing
This code requires sphincter pressure measurement. Use 43260 for diagnostic ERCP without manometry.
43262ERCP sphincterotomyPapillotomy performed
This code reports sphincter pressure measurement; 43262 reports therapeutic papillary sphincterotomy.
43264ERCP extractionDuct stones or debris
This code covers pressure measurement, while 43264 covers endoscopic removal of duct calculi.

Codes related to 43263

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

Codes related to 43263
CodeHow it relatesNational office range
Used instead
43260ERCP, brushing or washingUse for diagnostic ERCP when sphincter pressure measurement is not performed.No office rate
Often billed with
43262ERCP sphincterotomy, papillotomy performedPapillary sphincterotomy may be performed during the same ERCP when clinically indicated.No office rate
43264ERCP extraction, duct stones or debrisBile duct stone extraction may occur during the same ERCP when calculi are present.No office rate
43265ERCP lithotripsy, calculus destructionIntraductal lithotripsy may accompany ERCP when duct calculi require fragmentation.No office rate

43263 billing questions

When should this code be chosen instead of a diagnostic ERCP code?

Choose it when sphincter of Oddi pressure is actually measured during ERCP. A diagnostic ERCP without manometry does not support this code.

Can the diagnostic ERCP be reported separately for the same procedure?

The pressure-measurement service includes ERCP, so do not separately report a diagnostic ERCP code for the same access and study.

What documentation supports reporting this service?

The procedure report should identify the sphincter pressure measurements performed, the anatomy assessed, and the findings. ERCP imaging or cannulation alone is not enough.

How does CMS price it with another endoscopy?

When related endoscopies are performed together, CMS applies endoscopy-family pricing. The same-day preoperative and postoperative care is included under the 0-day global period.

Can modifier 50 or an assistant-at-surgery claim be used?

Modifier 50 is inappropriate for this code. Medicare does not pay an assistant at surgery for the service.

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 43263PPRRVU2026_Oct_nonQPP.csv, line 5,191 (RVU26D)

Open CMS sourceHow we calculate rates

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