CPT code 43276: ERCP stent exchange, with dilation2026 Medicare rate & RVUs in Missouri
Reports ERCP removal and exchange of a biliary or pancreatic duct stent, including dilation performed to facilitate the exchange.
CMS doesn’t publish an office rate for 43276 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 43276 covers
During ERCP, a gastroenterologist advances an endoscope through the mouth into the duodenum to reach a biliary or pancreatic duct. This service covers removing an existing duct stent and exchanging it for a replacement; dilation may be performed as part of that work. Exchanges may be needed when a stent is obstructed or has migrated, or as part of ongoing management of a duct stricture. ERCP is generally performed in a hospital or ambulatory endoscopy setting.
Report the service for each stent exchanged, and document the duct, stent removal and replacement, and any dilation performed. Dilation included in the exchange is not a separate service for that same work. When related endoscopies are performed together, CMS endoscopy-family pricing applies. The procedure has a 0-day global period, so same-day preoperative and postoperative care is included. Modifier 50 is inappropriate for this anatomy and descriptor. 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.
Where 43276 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 | $412.42 |
| Metropolitan St. Louis, MO | Unavailable | $414.52 |
| Rest of Missouri | Unavailable | $404.73 |
How the 43276 rate is calculated
Each of 43276’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 · 43276
RVUs × geographic indexes × conversion factor
Work8.62
8.62 RVUs× 1.000 GPCI
Practice expense2.95
2.95 RVUs× 1.000 GPCI
Malpractice0.98
0.98 RVUs× 1.000 GPCI
Adjusted RVUs
12.5500
Conversion factor
$33.4009
Medicare rate
$419.18
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 43276
The CMS indicators that decide how 43276 is paid alongside other services.
CMS payment indicators · 43276
ERCP stent exchange, with dilation
| 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
43276 without 51 · national facility
$419.18
ERCP stent exchange, with dilation
43276-51 · Second procedure: 50%
$209.59
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%).
43276 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 43274ERCP stentingBiliary or pancreatic duct
- 43274 is for placing a duct stent without exchanging an existing one. Choose 43276 when the procedure removes and replaces a stent.
- 43275ERCP removalDuct stent or foreign body
- 43275 describes removal without exchange. If a replacement stent is inserted, the exchange service is represented by 43276.
- 43277ERCP dilationEach duct or ampulla
- 43277 describes duct or ampullary dilation. Dilation performed as part of the stent exchange is included in 43276, rather than separately reported for that same work.
43276 billing questions
When should 43276 be selected instead of 43274?
Use 43276 when an existing biliary or pancreatic duct stent is removed and exchanged. Code 43274 describes placement of a stent without the exchange service.
How is the number of units determined?
Report one unit for each stent exchanged. The record should identify the stents removed and replaced.
Can dilation be reported separately?
Dilation performed as part of the stent exchange is included. Document the duct and the work performed; do not separately report that same dilation as 43277.
Can 43275 be used when the stent is removed?
43275 describes removal without exchange. When the existing stent is removed and replaced, 43276 represents the exchange service.
Does modifier 50 apply, or can an assistant be paid?
Modifier 50 is inappropriate for this code. Medicare does not pay an assistant at surgery for 43276.
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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