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CPT code 43264: ERCP extraction, duct stones or debris2026 Medicare rate & RVUs

Report this ERCP therapeutic service when an endoscopist extracts stones or debris from a biliary or pancreatic duct without fragmenting them.

CMS RVU26DEffective Oct 1, 2026109 payment localities55.4K Medicare services in 2024

Medicare pays $317.31 for 43264 nationally in a facility.

Medicare rate · 43264

ERCP extraction, duct stones or debris

Office or facility?

Work RVUs
6.46
Total RVUs
9.50
Global days
000

National rate · 2026

$317.31

Facility setting, before claim adjustments.

See every locality for 43264 →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 43264 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 43264 covers

During ERCP, a gastroenterologist or other qualified endoscopist passes a side-viewing endoscope through the mouth to the duodenum, accesses the biliary or pancreatic duct, and retrieves calculi or debris, commonly with a balloon or basket. Typical cases include removing common bile duct stones in a patient with choledocholithiasis or clearing ductal debris. The service is performed in settings such as a hospital or ambulatory surgery center.

Report this code when the documented work includes ductal stone or debris extraction; use the distinct lithotripsy service when calculi are fragmented. The record should identify the treated duct and describe the retrieval performed. 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. Medicare does not pay an assistant at surgery for this service, 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 43264 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

43264 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$297.19
AlaskaUnavailable$419.43
ArizonaUnavailable$311.44
ArkansasUnavailable$294.72
Atlanta, GAUnavailable$324.03
Austin, TXUnavailable$319.49
Bakersfield, CAUnavailable$319.44
Baltimore area, MDUnavailable$332.12
Beaumont, TXUnavailable$308.63
Brazoria, TXUnavailable$313.05

43264 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
43264 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 43264 rate is calculated

Each of 43264’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 · 43264

RVUs × geographic indexes × conversion factor

Office or facility?

Work6.46

6.46 RVUs× 1.000 GPCI

Practice expense2.32

2.32 RVUs× 1.000 GPCI

Malpractice0.72

0.72 RVUs× 1.000 GPCI

Adjusted RVUs

9.5000

Conversion factor

$33.4009

Medicare rate

$317.31

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

Payment rules and modifiers for 43264

The CMS indicators that decide how 43264 is paid alongside other services.

CMS payment indicators · 43264

ERCP extraction, duct stones or debris

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

43264 without 51 · national facility

$317.31

ERCP extraction, duct stones or debris

43264-51 · Second procedure: 50%

$158.66

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

43264 compared with similar codes

Compare codes · National

4 codes, side by side

Office or facility?

  • 43264

    ERCP extraction, duct stones or debris6.46 wRVU

    Not priced

  • 43265

    ERCP lithotripsy, calculus destruction7.73 wRVU

    Not priced

  • 43260

    ERCP, brushing or washing5.7 wRVU

    Not priced

  • 43275

    ERCP removal, duct stent or foreign body6.69 wRVU

    Not priced

How to choose

43265ERCP lithotripsyCalculus destruction
43264 represents extraction of stones or debris. Choose 43265 when the endoscopist fragments or destroys calculi during ERCP.
43260ERCPBrushing or washing
43260 describes diagnostic ERCP without the ductal stone or debris extraction represented by 43264.
43275ERCP removalDuct stent or foreign body
43275 concerns removal of a foreign body from a duct; 43264 is for extracting calculi or debris.

Codes related to 43264

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

Codes related to 43264
CodeHow it relatesNational office range
Used instead
43265ERCP lithotripsy, calculus destructionUse when the ERCP treatment destroys or fragments duct calculi rather than extracting them alone.No office rate
43260ERCP, brushing or washingDiagnostic ERCP applies when the encounter does not include duct-stone or debris extraction.No office rate
43275ERCP removal, duct stent or foreign bodyFor removal of a duct foreign body, rather than calculi or debris.No office rate

43264 billing questions

How does this differ from ERCP lithotripsy?

Use this code for extracting stones or debris without fragmentation. When the endoscopist destroys or fragments calculi, compare the service with 43265.

What documentation supports reporting this service?

Document the biliary or pancreatic duct treated, the presence of calculi or debris, and the extraction performed, such as retrieval with a balloon or basket.

Can modifier 50 be used for stones in two ducts?

No. CMS identifies bilateral adjustment as inappropriate for this code; the anatomy and descriptor do not support modifier 50.

How are related ERCP services priced on the same date?

When related endoscopies are performed together, CMS applies endoscopy family pricing rather than treating each service as an unrelated endoscopy for payment.

Is same-day postoperative care included?

Yes. The 0-day global period 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 43264PPRRVU2026_Oct_nonQPP.csv, line 5,192 (RVU26D)

Open CMS sourceHow we calculate rates

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