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Billing code 43260: ERCPMedicare rate & RVUs

Diagnostic ERCP with ductal brushing or washing is reported when the endoscopist collects specimens from the biliary or pancreatic ducts.

CMS RVU26DEffective Oct 1, 2026109 payment localities3.2K Medicare services in 2024

Medicare pays $280.90 for 43260 nationally in a facility.

Medicare rate · 43260

ERCP

Swap in your local Medicare rate.

Work RVUs
5.7
Total RVUs
8.41
Global days
000

National rate · 2026

$280.90

Facility setting, before claim adjustments.

See every locality for 43260 → · 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.

On this page 10 sections
  1. Medicare rate
  2. What 43260 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 43260 covers

A gastroenterologist advances an endoscope through the mouth to the duodenum, accesses the biliary or pancreatic ducts, and uses contrast imaging to evaluate ductal anatomy. This service includes collecting duct specimens by brushing or washing when performed. It may be used to investigate a suspected ductal stricture, obstruction, or other abnormality, often in a hospital or ambulatory endoscopy facility.

Report 43260 when the documented ERCP includes brushing or washing for specimen collection; forceps tissue sampling is distinguished by 43261. Documentation should identify the duct examined, the collection method, and the findings. The 0-day global period includes same-day preoperative and postoperative care. For multiple procedures in one session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% reduction. Modifier 50 is inappropriate for this service. Medicare does not pay an assistant at surgery; 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 43260 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

43260 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$263.19
Alaska*Unavailable$371.33
ArizonaUnavailable$275.76
ArkansasUnavailable$261.02
AtlantaUnavailable$286.75
AustinUnavailable$282.97
BakersfieldUnavailable$283.12
Baltimore/Surr. CntysUnavailable$293.95
BeaumontUnavailable$273.15
BrazoriaUnavailable$277.24

43260 rates by state

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

MEWIVTNHMTNDMNMINYMARIWAIDWYSDIAILINOHPANJCTORNVUTCONEMOKYWVVAMDDECAAZNMKSOKARTNNCSCDCTXLAMSALGAFLAKHI

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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
43260 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 43260 rate is calculated

Each of 43260’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 · 43260

RVUs × geographic indexes × conversion factor

Swap in your local Medicare rate.

Work 5.70Practice expense 2.09Malpractice 0.62

8.4100 adjusted RVUs×$33.4009 conversion factor=$280.90

All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.

Payment rules and modifiers for 43260

The CMS indicators that decide how 43260 is paid alongside other services.

CMS payment indicators · 43260

ERCP

RuleCMS valueWhat it means
Global period000Same-day global: pre- and post-op care on the day of the procedure is included.
Multiple procedures2Standard reduction: highest-valued procedure at 100%, others at 50%.
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

43260 without 51 · national facility

$280.90

ERCP

43260-51 · Second procedure: 50%

$140.45

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

43260 compared with similar codes

Compare codes

43260 vs 43261 vs 43262 vs 43264 vs 43274: national Medicare rates

Swap in your local Medicare rate.

  • 43260
    ERCP · 5.7 wRVU
    —
  • 43261
    ERCP · 6 wRVU
    —
  • 43262
    ERCP sphincterotomy · 6.34 wRVU
    —
  • 43264
    ERCP extraction · 6.46 wRVU
    —
  • 43274
    ERCP stenting · 8.27 wRVU
    —

How to choose

43261ERCP
43260 covers duct specimen collection by brushing or washing. Choose 43261 for tissue sampling by biopsy.
43262ERCP sphincterotomy
43262 describes ERCP with sphincterotomy or papillotomy, a duct-opening intervention rather than specimen collection.
43264ERCP extraction
43264 is for ERCP with duct calculus removal; 43260 describes diagnostic duct evaluation with brushing or washing.
43274ERCP stenting
43274 describes ERCP with duct stent placement. A stent procedure is distinct from the specimen-collection service in 43260.

Codes related to 43260

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

Codes related to 43260
CodeHow it relatesNational office range
Same family
43261ERCPERCP with ductal forceps biopsy rather than brushing or washing.No office rate
43262ERCP sphincterotomyERCP that includes sphincterotomy or papillotomy.No office rate
43263ERCP manometryERCP with measurement of sphincter pressure.No office rate
43264ERCP extractionERCP with removal of duct calculi.No office rate
43274ERCP stentingERCP with placement of a duct stent.No office rate

43260 billing questions

When should 43260 be chosen instead of 43261?

Use 43260 for ERCP with ductal specimen collection by brushing or washing. Use 43261 when the endoscopist takes tissue by biopsy.

Is brushing or washing separately reported?

The ductal brushing or washing specimen collection is included in 43260. The operative report should state the collection method and site.

Can 43260 be reported with an ERCP treatment code?

Code the ERCP services actually performed and documented, including therapeutic work when supported. When multiple procedures occur in the same session, CMS applies the multiple-procedure reduction to the lower-valued procedures.

Should modifier 50 be appended?

No. Modifier 50 is inappropriate for this ERCP service.

Can an assistant or co-surgeon be paid for 43260?

Medicare does not pay an assistant at surgery for this service, and 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 43260PPRRVU2026_Oct_nonQPP.csv, line 5,188 (RVU26D)

Open CMS sourceHow we calculate rates

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