CPT code 43276: ERCP stent exchange, with dilation2026 Medicare rate & RVUs in Utah
Reports ERCP removal and exchange of a biliary or pancreatic duct stent, including dilation performed to facilitate the exchange.
In Utah, Medicare pays $409.93 for 43276 in a facility. There’s no office rate.
Check a contract rate as a % of Medicare · 43276 nationwide
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
On this page 11 sections
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.
How Utah compares for 43276
Across 109 of 109 payment localities, the facility rate for 43276 runs from $389.41 in Arkansas to $554.85 in Alaska. Utah pays $409.93. The RVUs are the same everywhere; the geographic indexes change the dollars.
- Utah · this page$409.93
- Los Angeles, CA · California$438.02+$28.09
- Washington, DC area · District of Columbia$455.97+$46.04
- Miami, FL · Florida$473.27+$63.34
- Chicago, IL · Illinois$464.08+$54.15
- Manhattan, NY · New York$472.75+$62.82
- Alaska · Alaska$554.85+$144.92
Other areas in Utah first, then benchmark localities. Bars start at $0.
Every other payment area
| Payment locality | Office | Facility |
|---|---|---|
| AlabamaAlabama | — | $392.66 |
| ArkansasArkansas | — | $389.41 |
| ArizonaArizona | — | $411.41 |
| Bakersfield, CACalifornia | — | $421.31 |
| Chico, CACalifornia | — | $418.35 |
| El Centro, CACalifornia | — | $418.51 |
| Fresno, CACalifornia | — | $418.35 |
| Hanford, CACalifornia | — | $418.35 |
| Madera, CACalifornia | — | $418.35 |
| Merced, CACalifornia | — | $418.35 |
| Modesto, CACalifornia | — | $418.35 |
| Napa, CACalifornia | — | $452.55 |
| Oxnard, CACalifornia | — | $432.84 |
| Redding, CACalifornia | — | $418.35 |
| Rest of CaliforniaCalifornia | — | $418.35 |
| Riverside, CACalifornia | — | $429.01 |
| Sacramento, CACalifornia | — | $430.42 |
| Salinas, CACalifornia | — | $428.59 |
| San Diego, CACalifornia | — | $432.14 |
| Marin County, CACalifornia | — | $469.22 |
| San Francisco, CACalifornia | — | $468.11 |
| San Benito County, CACalifornia | — | $479.22 |
| Santa Clara County, CACalifornia | — | $474.67 |
| San Luis Obispo, CACalifornia | — | $422.58 |
| Santa Cruz, CACalifornia | — | $431.22 |
| Santa Maria, CACalifornia | — | $428.41 |
| Santa Rosa, CACalifornia | — | $435.10 |
| Stockton, CACalifornia | — | $418.35 |
| Vallejo, CACalifornia | — | $450.94 |
| Visalia, CACalifornia | — | $418.35 |
| Yuba City, CACalifornia | — | $418.35 |
| ColoradoColorado | — | $421.77 |
| ConnecticutConnecticut | — | $439.40 |
| DelawareDelaware | — | $416.13 |
| Fort Lauderdale, FLFlorida | — | $446.91 |
| Rest of FloridaFlorida | — | $431.31 |
| Atlanta, GAGeorgia | — | $428.20 |
| Rest of GeorgiaGeorgia | — | $414.82 |
| Hawaii, Guam, HIHawaii | — | $418.90 |
| IowaIowa | — | $391.07 |
| IdahoIdaho | — | $394.05 |
| East St. Louis, ILIllinois | — | $444.49 |
| Rest of IllinoisIllinois | — | $429.04 |
| Suburban Chicago, ILIllinois | — | $449.13 |
| IndianaIndiana | — | $395.16 |
| KansasKansas | — | $393.49 |
| KentuckyKentucky | — | $405.46 |
| New Orleans, LALouisiana | — | $417.82 |
| Rest of LouisianaLouisiana | — | $406.48 |
| Metropolitan Boston, MAMassachusetts | — | $446.50 |
| Rest of MassachusettsMassachusetts | — | $422.37 |
| Baltimore area, MDMaryland | — | $438.74 |
| Rest of MarylandMaryland | — | $420.56 |
| Rest of MaineMaine | — | $398.93 |
| Southern Maine, MEMaine | — | $406.22 |
| Detroit, MIMichigan | — | $438.19 |
| Rest of MichiganMichigan | — | $414.83 |
| MinnesotaMinnesota | — | $398.99 |
| Metropolitan Kansas City, MOMissouri | — | $412.42 |
| Metropolitan St. Louis, MOMissouri | — | $414.52 |
| Rest of MissouriMissouri | — | $404.73 |
| MississippiMississippi | — | $396.94 |
| MontanaMontana | — | $419.12 |
| North CarolinaNorth Carolina | — | $400.76 |
| North DakotaNorth Dakota | — | $399.74 |
| NebraskaNebraska | — | $391.23 |
| New HampshireNew Hampshire | — | $419.13 |
| Northern New JerseyNew Jersey | — | $455.31 |
| Rest of New JerseyNew Jersey | — | $442.94 |
| New MexicoNew Mexico | — | $417.58 |
| NevadaNevada | — | $413.81 |
| NYC suburbs and Long Island, NYNew York | — | $484.28 |
| Poughkeepsie and northern NYC suburbs, NYNew York | — | $448.37 |
| Queens, NYNew York | — | $470.01 |
| Rest of New YorkNew York | — | $404.53 |
| OhioOhio | — | $410.87 |
| OklahomaOklahoma | — | $401.34 |
| Portland, OROregon | — | $426.35 |
| Rest of OregonOregon | — | $409.07 |
| Metropolitan Philadelphia, PAPennsylvania | — | $434.72 |
| Rest of PennsylvaniaPennsylvania | — | $409.30 |
| Puerto RicoPuerto Rico | — | $419.77 |
| Rhode IslandRhode Island | — | $424.37 |
| South CarolinaSouth Carolina | — | $406.78 |
| South DakotaSouth Dakota | — | $397.45 |
| TennesseeTennessee | — | $395.06 |
| Austin, TXTexas | — | $421.74 |
| Beaumont, TXTexas | — | $407.99 |
| Brazoria, TXTexas | — | $413.40 |
| Dallas, TXTexas | — | $416.73 |
| Fort Worth, TXTexas | — | $416.17 |
| Galveston, TXTexas | — | $415.16 |
| Houston, TXTexas | — | $433.10 |
| Rest of TexasTexas | — | $410.98 |
| VirginiaVirginia | — | $407.88 |
| Virgin Islands, VIUnited States Virgin Islands | — | $419.77 |
| VermontVermont | — | $402.03 |
| Rest of WashingtonWashington | — | $420.32 |
| King County, WAWashington | — | $449.95 |
| WisconsinWisconsin | — | $392.39 |
| West VirginiaWest Virginia | — | $420.38 |
| WyomingWyoming | — | $410.67 |
43276 rates by state
Office rate range in each state. Select a state to see its payment localities.
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
| State / territory | Office rate range | Localities |
|---|---|---|
| AK | No published base rate | 1 |
| AL | No published base rate | 1 |
| AR | No published base rate | 1 |
| AZ | No published base rate | 1 |
| CA | No published base rate | 29 |
| CO | No published base rate | 1 |
| CT | No published base rate | 1 |
| DC | No published base rate | 1 |
| DE | No published base rate | 1 |
| FL | No published base rate | 3 |
| GA | No published base rate | 2 |
| GU | No published base rate | 1 |
| HI | No published base rate | 1 |
| IA | No published base rate | 1 |
| ID | No published base rate | 1 |
| IL | No published base rate | 4 |
| IN | No published base rate | 1 |
| KS | No published base rate | 1 |
| KY | No published base rate | 1 |
| LA | No published base rate | 2 |
| MA | No published base rate | 2 |
| MD | No published base rate | 3 |
| ME | No published base rate | 2 |
| MI | No published base rate | 2 |
| MN | No published base rate | 1 |
| MO | No published base rate | 3 |
| MS | No published base rate | 1 |
| MT | No published base rate | 1 |
| NC | No published base rate | 1 |
| ND | No published base rate | 1 |
| NE | No published base rate | 1 |
| NH | No published base rate | 1 |
| NJ | No published base rate | 2 |
| NM | No published base rate | 1 |
| NV | No published base rate | 1 |
| NY | No published base rate | 5 |
| OH | No published base rate | 1 |
| OK | No published base rate | 1 |
| OR | No published base rate | 2 |
| PA | No published base rate | 2 |
| PR | No published base rate | 1 |
| RI | No published base rate | 1 |
| SC | No published base rate | 1 |
| SD | No published base rate | 1 |
| TN | No published base rate | 1 |
| TX | No published base rate | 8 |
| UT | No published base rate | 1 |
| VA | No published base rate | 2 |
| VI | No published base rate | 1 |
| VT | No published base rate | 1 |
| WA | No published base rate | 2 |
| WI | No published base rate | 1 |
| WV | No published base rate | 1 |
| WY | No published base rate | 1 |
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.
The exact Utah inputs and CMS source lines
PPRRVU2026_Oct_nonQPP.csv
5,200
- Code
- 43276
- Physician work
- 8.62
- Practice expense
- 2.95
- Malpractice
- 0.98
GPCI2026.csv
104
- Locality
- Utah
- Physician work
- 1.000
- Practice expense
- 0.940
- Malpractice
- 0.898
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 8.62 | × 1.000 | 8.6200 |
| Practice expense | 2.95 | × 0.940 | 2.7730 |
| Malpractice | 0.98 | × 0.898 | 0.8800 |
| Total RVUs | 12.2730 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Utah$409.93
Facility: (8.62 × 1 + 2.95 × 0.94 + 0.98 × 0.898) × $33.4009 = $409.93
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%).
How 43276 has changed in Utah
43276 · Office / nonfacility
Rate unavailable
Effective 2026-10-01
A rate is unavailable in one of these releases, so a change cannot be calculated.
One bar per available release, ordered by effective date. Missing rates remain gaps. These comparisons hold the code, setting and locality identifiers constant; they do not isolate which policy or input caused a change.
What changed, release by release
January 1, 2014
RVU14A
No ratechanged toNo rate
Held through RVU14B, RVU14C, RVU14D, RVU15A, RVU15B, RVU15C, RVU15D, RVU16A, RVU16B, RVU16C, RVU16D, RVU17A, RVU17B, RVU17C, RVU17D, RVU18AR1, RVU18B, RVU18C, RVU18D, RVU19A, RVU19B, RVU19C, RVU19D, RVU20A, RVU20B, RVU20C, RVU20D, RVU21A, RVU21B, RVU21C, RVU21D, RVU22A, RVU22B, RVU22C, RVU22D, RVU23A, RVU23B, RVU23C, RVU23D, RVU24A, RVU24AR, RVU24B, RVU24C, RVU24D, RVU25A, RVU25B, RVU25C, RVU25D, RVU26A, RVU26B, RVU26C, RVU26D.
January 1, 2013
RVU13AR
Earliest loaded release: No rate
Held through RVU13B, RVU13C, RVU13D.
| Effective from | Office | Facility | CMS release |
|---|---|---|---|
| 2026-10-01 | Not available in this setting | $409.93 | RVU26D |
| 2026-07-01 | Not available in this setting | $409.93 | RVU26C |
| 2026-04-01 | Not available in this setting | $409.93 | RVU26B |
| 2026-01-01 | Not available in this setting | $409.93 | RVU26A |
| 2025-10-01 | Not available in this setting | $446.70 | RVU25D |
| 2025-07-01 | Not available in this setting | $446.70 | RVU25C |
| 2025-04-01 | Not available in this setting | $446.70 | RVU25B |
| 2025-01-01 | Not available in this setting | $446.70 | RVU25A |
| 2024-10-01 | Not available in this setting | $459.69 | RVU24D |
| 2024-07-01 | Not available in this setting | $459.69 | RVU24C |
| 2024-04-01 | Not available in this setting | $459.69 | RVU24B |
| 2024-03-09 | Not available in this setting | $459.69 | RVU24AR |
| 2024-01-01 | Not available in this setting | $452.19 | RVU24A |
| 2023-10-01 | Not available in this setting | $462.20 | RVU23D |
| 2023-07-01 | Not available in this setting | $462.20 | RVU23C |
| 2023-04-01 | Not available in this setting | $462.20 | RVU23B |
| 2023-01-01 | Not available in this setting | $462.20 | RVU23A |
| 2022-10-01 | Not available in this setting | $468.82 | RVU22D |
| 2022-07-01 | Not available in this setting | $468.82 | RVU22C |
| 2022-04-01 | Not available in this setting | $468.82 | RVU22B |
| 2022-01-01 | Not available in this setting | $468.82 | RVU22A |
| 2021-10-01 | Not available in this setting | $470.62 | RVU21D |
| 2021-07-01 | Not available in this setting | $470.62 | RVU21C |
| 2021-04-01 | Not available in this setting | $470.62 | RVU21B |
| 2021-01-01 | Not available in this setting | $470.62 | RVU21A |
| 2020-10-01 | Not available in this setting | $489.54 | RVU20D |
| 2020-07-01 | Not available in this setting | $489.54 | RVU20C |
| 2020-04-01 | Not available in this setting | $489.54 | RVU20B |
| 2020-01-01 | Not available in this setting | $489.54 | RVU20A |
| 2019-10-01 | Not available in this setting | $504.59 | RVU19D |
| 2019-07-01 | Not available in this setting | $504.59 | RVU19C |
| 2019-04-01 | Not available in this setting | $504.59 | RVU19B |
| 2019-01-01 | Not available in this setting | $504.59 | RVU19A |
| 2018-10-01 | Not available in this setting | $505.62 | RVU18D |
| 2018-07-01 | Not available in this setting | $505.62 | RVU18C |
| 2018-04-01 | Not available in this setting | $505.62 | RVU18B |
| 2018-01-01 | Not available in this setting | $505.62 | RVU18AR1 |
| 2017-10-01 | Not available in this setting | $504.17 | RVU17D |
| 2017-07-01 | Not available in this setting | $504.17 | RVU17C |
| 2017-04-01 | Not available in this setting | $504.17 | RVU17B |
| 2017-01-01 | Not available in this setting | $504.17 | RVU17A |
| 2016-10-01 | Not available in this setting | $508.10 | RVU16D |
| 2016-07-01 | Not available in this setting | $508.10 | RVU16C |
| 2016-04-01 | Not available in this setting | $508.10 | RVU16B |
| 2016-01-01 | Not available in this setting | $508.10 | RVU16A |
| 2015-10-01 | Not available in this setting | $519.04 | RVU15D |
| 2015-07-01 | Not available in this setting | $519.04 | RVU15C |
| 2015-04-01 | Not available in this setting | $516.46 | RVU15B |
| 2015-01-01 | Not available in this setting | $516.46 | RVU15A |
| 2014-10-01 | Not available in this setting | $511.66 | RVU14D |
| 2014-07-01 | Not available in this setting | $511.66 | RVU14C |
| 2014-04-01 | Not available in this setting | $511.66 | RVU14B |
| 2014-01-01 | Not available in this setting | $511.66 | RVU14A |
| 2013-10-01 | Not in this release | Not in this release | RVU13D |
| 2013-07-01 | Not in this release | Not in this release | RVU13C |
| 2013-04-01 | Not in this release | Not in this release | RVU13B |
| 2013-01-01 | Not in this release | Not in this release | RVU13AR |
Where the Utah rate applies
Utah is a Medicare payment area, not a city. Our Census mapping connects it to 334 cities and communities in Utah. Some span more than one payment area; confirm with the service ZIP.
- Alpine
- Alta
- Altamont
- Alton
- Amalga
- American Fork
- Aneth
- Annabella
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
Show the CMS file lines behind this rate
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