CPT code 43278: ERCP ablation, with dilation when performed2026 Medicare rate & RVUs in New Mexico

In New Mexico, Medicare pays $374.84 for 43278 in a facility. There’s no office rate.

Check a contract rate as a % of Medicare · 43278 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 43278 covers

During ERCP, the endoscopist advances an endoscope to the duodenum, accesses the biliary or pancreatic duct, and ablates a ductal tumor, polyp, or other lesion. The service is typically performed by a gastroenterologist in a hospital or endoscopy facility, often to treat an intraductal lesion identified during evaluation or treatment of a duct abnormality. Guidewire passage and pre- or post-ablation dilation are included when performed; dilation alone is not the defining service.

Select this code when the documented ERCP includes ablation of a ductal lesion, rather than dilation alone, stone removal, or stent work without lesion ablation. The procedure note should identify the treated duct and lesion, describe the ablation performed, and record any associated dilation. 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. Medicare does not pay an assistant at surgery for this code; 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 New Mexico compares for 43278

Across 109 of 109 payment localities, the facility rate for 43278 runs from $349.71 in Arkansas to $498.13 in Alaska. New Mexico pays $374.84. The RVUs are the same everywhere; the geographic indexes change the dollars.

Every other payment area

43278 rates by state

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

See 43278 in every payment locality

How the 43278 rate is calculated

Each of 43278’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 43278

The CMS indicators that decide how 43278 is paid alongside other services.

What modifiers do to the payment

When to use modifier 51

Codes related to 43278

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

How 43278 has changed in New Mexico

Price 43278 for an earlier date of service

Where the New Mexico rate applies

New Mexico is a Medicare payment area, not a city. Our Census mapping connects it to 528 cities and communities in New Mexico. Some span more than one payment area; confirm with the service ZIP.

• Abeytas
• Abiquiu
• Acomita Lake
• Adelino
• Agua Fria
• Alamillo
• Alamo
• Alamogordo

Browse all communities in New Mexico

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