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CPT code 43277: ERCP dilation, each duct or ampulla2026 Medicare rate & RVUs

ERCP balloon dilation enlarges a narrowed biliary or pancreatic duct, or the ampulla, and is reported for each treated duct during therapeutic endoscopy.

CMS RVU26DEffective Oct 1, 2026109 payment localities6K Medicare services in 2024

Medicare pays $330.00 for 43277 nationally in a facility.

Medicare rate · 43277

ERCP dilation, each duct or ampulla

Office or facility?

Work RVUs
6.73
Total RVUs
9.88
Global days
000

National rate · 2026

$330.00

Facility setting, before claim adjustments.

See every locality for 43277 →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 43277 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 43277 covers

During ERCP, the endoscopist guides a balloon to a narrowed biliary or pancreatic duct, or the ampulla, and expands it to improve passage through the narrowed area. Gastroenterologists and other endoscopists with therapeutic ERCP expertise typically perform this in a hospital or ambulatory endoscopy facility. Common indications include a duct stricture or papillary narrowing. Sphincterotomy, when performed as part of the dilation service, is included.

Report the service for each duct treated; documentation should identify the duct or ampulla and the dilation performed. This is a minor procedure with a 0-day global period, so same-day preoperative and postoperative care is included. When related endoscopies are performed together, Medicare applies endoscopy family pricing rather than treating each service as unrelated. Modifier 50 is inappropriate for this anatomy and service. Medicare does not pay an assistant at surgery, and co-surgeons and team surgery are not permitted for this code.

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 43277 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

43277 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$309.11
AlaskaUnavailable$436.36
ArizonaUnavailable$323.91
ArkansasUnavailable$306.55
Atlanta, GAUnavailable$336.99
Austin, TXUnavailable$332.24
Bakersfield, CAUnavailable$332.17
Baltimore area, MDUnavailable$345.39
Beaumont, TXUnavailable$321.01
Brazoria, TXUnavailable$325.57

43277 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
43277 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 43277 rate is calculated

Each of 43277’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 · 43277

RVUs × geographic indexes × conversion factor

Office or facility?

Work6.73

6.73 RVUs× 1.000 GPCI

Practice expense2.40

2.40 RVUs× 1.000 GPCI

Malpractice0.75

0.75 RVUs× 1.000 GPCI

Adjusted RVUs

9.8800

Conversion factor

$33.4009

Medicare rate

$330.00

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

Payment rules and modifiers for 43277

The CMS indicators that decide how 43277 is paid alongside other services.

CMS payment indicators · 43277

ERCP dilation, each duct or ampulla

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

43277 without 51 · national facility

$330.00

ERCP dilation, each duct or ampulla

43277-51 · Second procedure: 50%

$165.00

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

43277 compared with similar codes

Compare codes · National

5 codes, side by side

Office or facility?

  • 43277

    ERCP dilation, each duct or ampulla6.73 wRVU

    Not priced

  • 43264

    ERCP extraction, duct stones or debris6.46 wRVU

    Not priced

  • 43276

    ERCP stent exchange, with dilation8.62 wRVU

    Not priced

  • 43278

    ERCP ablation, with dilation when performed7.72 wRVU

    Not priced

  • 43274

    ERCP stenting, biliary or pancreatic duct8.27 wRVU

    Not priced

How to choose

43264ERCP extractionDuct stones or debris
43277 describes balloon dilation of a duct or ampulla; 43264 describes duct-stone extraction. The procedures may occur during the same ERCP when both are performed.
43276ERCP stent exchangeWith dilation
43276 applies when a duct stent is removed and exchanged, with dilation included when performed. Use 43277 for duct or ampulla dilation when stent exchange is not the service being described.
43278ERCP ablationWith dilation when performed
43278 describes lesion ablation with dilation. 43277 describes dilation without that ablation service.
43274ERCP stentingBiliary or pancreatic duct
43274 describes placement of a duct stent. 43277 describes balloon dilation; choose based on the documented intervention, not simply the presence of a duct narrowing.

Codes related to 43277

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

Codes related to 43277
CodeHow it relatesNational office range
Often billed with
43264ERCP extraction, duct stones or debrisDuct-stone extraction may be performed during the same ERCP as a distinct dilation service.No office rate
43274ERCP stenting, biliary or pancreatic ductDuct stent placement may accompany dilation when both services are performed and documented.No office rate
Used instead
43276ERCP stent exchange, with dilationUse for stent removal and exchange when dilation is part of that exchange service.No office rate
43278ERCP ablation, with dilation when performedUse when lesion ablation with dilation is the service performed; dilation is included in that service.No office rate

43277 billing questions

How is 43277 distinguished from stone-removal ERCP?

Use 43277 for balloon dilation of a duct or the ampulla. When the documented intervention is duct-stone extraction, compare it with 43264; dilation alone does not describe extraction.

Can 43277 be reported for more than one duct?

The code is reported for each duct treated. Document the specific duct or ducts dilated and the work performed at each site.

Is sphincterotomy separately reported with 43277?

Sphincterotomy performed as part of the dilation is included. Do not separately report it as though it were an unrelated service.

Should modifier 50 be used for dilation on both sides?

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

What same-day care is included in the global period?

The 0-day global period includes same-day preoperative and postoperative care. It does not extend the global period beyond the procedure date.

Can an assistant surgeon or co-surgeon be paid for 43277?

Medicare does not pay an assistant at surgery for this code. Co-surgeons and team surgery are not permitted.

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 43277PPRRVU2026_Oct_nonQPP.csv, line 5,201 (RVU26D)

Open CMS sourceHow we calculate rates

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