CPT code 43264: ERCP extraction, duct stones or debris2026 Medicare rate & RVUs in Missouri
Report this ERCP therapeutic service when an endoscopist extracts stones or debris from a biliary or pancreatic duct without fragmenting them.
CMS doesn’t publish an office rate for 43264 in Missouri.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
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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 in Missouri
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
| Payment locality | Office | Facility |
|---|---|---|
| Metropolitan Kansas City, MO | Unavailable | $312.03 |
| Metropolitan St. Louis, MO | Unavailable | $313.64 |
| Rest of Missouri | Unavailable | $305.99 |
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
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
| 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
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%).
43264 compared with similar codes
Compare codes · National
4 codes, side by side
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.
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
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