CPT code 43265: ERCP lithotripsy, calculus destruction2026 Medicare rate & RVUs in Montana

In Montana, Medicare pays $376.70 for 43265 in a facility. There’s no office rate.

Check a contract rate as a % of Medicare · 43265 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 43265 covers

During ERCP, an endoscope is advanced to the duodenum and instruments are passed into the biliary or pancreatic ducts to fragment calculi. A gastroenterologist or other trained endoscopist may use mechanical, electrohydraulic, or laser lithotripsy, often for stones that are difficult to remove intact. These procedures are generally performed in a hospital or ambulatory surgery center.

Report this service when the endoscopist documents active destruction or fragmentation of duct calculi, including the treated duct and method when available. Distinguish it from code 43264 when the service is duct-stone removal without lithotripsy. The CMS 0-day global period includes same-day preoperative and postoperative care. When related endoscopies are performed together, endoscopy family pricing applies. Modifier 50 is inappropriate for this descriptor and anatomy. Medicare does not pay an assistant at surgery for this service; 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.

How Montana compares for 43265

Across 109 of 109 payment localities, the facility rate for 43265 runs from $350.05 in Arkansas to $498.63 in Alaska. Montana pays $376.70. The RVUs are the same everywhere; the geographic indexes change the dollars.

Every other payment area

43265 rates by state

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

See 43265 in every payment locality

How the 43265 rate is calculated

Each of 43265’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 43265

The CMS indicators that decide how 43265 is paid alongside other services.

What modifiers do to the payment

When to use modifier 51

Codes related to 43265

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

How 43265 has changed in Montana

Price 43265 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