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Billing code 43274: ERCP stentingMedicare rate & RVUs

Reports endoscopic placement of a stent in a bile or pancreatic duct during ERCP, including related guidewire passage and specified accompanying maneuvers.

CMS RVU26DEffective Oct 1, 2026109 payment localities40.8K Medicare services in 2024

Medicare pays $402.15 for 43274 nationally in a facility.

Medicare rate · 43274

ERCP stenting

Swap in your local Medicare rate.

Work RVUs
8.27
Total RVUs
12.04
Global days
000

National rate · 2026

$402.15

Facility setting, before claim adjustments.

See every locality for 43274 → · 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 43274 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 43274 covers

During ERCP, a gastroenterologist advances a side-viewing endoscope through the mouth to the duodenum, accesses the biliary or pancreatic duct, and places a stent to maintain drainage or passage. Typical situations include duct narrowing, obstruction, or a leak requiring endoscopic drainage. The service is most often performed in a hospital or ambulatory endoscopy facility.

Report 43274 when the procedure includes ductal stent placement. The operative report should identify the duct treated, the reason for stenting, and the placement performed. Guidewire passage, pre- or post-dilation, and sphincterotomy are included when performed as part of this service. The code has a 0-day global period, so same-day preoperative and postoperative care is included. When related endoscopies are performed together, endoscopy family pricing applies. Modifier 50 is inappropriate for this code; Medicare also does not pay an assistant at surgery, co-surgeons, or a surgical team for it.

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 43274 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

43274 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$376.91
Alaska*Unavailable$532.65
ArizonaUnavailable$394.77
ArkansasUnavailable$373.82
AtlantaUnavailable$410.68
AustinUnavailable$404.72
BakersfieldUnavailable$404.52
Baltimore/Surr. CntysUnavailable$420.80
BeaumontUnavailable$391.40
BrazoriaUnavailable$396.74

43274 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
43274 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 43274 rate is calculated

Each of 43274’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 · 43274

RVUs × geographic indexes × conversion factor

Swap in your local Medicare rate.

Work 8.27Practice expense 2.85Malpractice 0.92

12.0400 adjusted RVUs×$33.4009 conversion factor=$402.15

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

Payment rules and modifiers for 43274

The CMS indicators that decide how 43274 is paid alongside other services.

CMS payment indicators · 43274

ERCP stenting

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

43274 without 51 · national facility

$402.15

ERCP stenting

43274-51 · Second procedure: 50%

$201.08

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

43274 compared with similar codes

Compare codes

43274 vs 43276 vs 43266 vs 43264: national Medicare rates

Swap in your local Medicare rate.

  • 43274
    ERCP stenting · 8.27 wRVU
    —
  • 43276
    ERCP stent exchange · 8.62 wRVU
    —
  • 43266
    Endoscopic stent · 3.82 wRVU
    —
  • 43264
    ERCP extraction · 6.46 wRVU
    —

How to choose

43276ERCP stent exchange
Choose 43274 for ductal stent placement. Choose 43276 when an existing ductal stent is removed and exchanged.
43266Endoscopic stent
43266 describes endoscopic stent placement in the upper GI tract. 43274 is for placement in a biliary or pancreatic duct during ERCP.
43264ERCP extraction
43264 reports ERCP removal of ductal calculi; 43274 reports ductal stent placement. The operative report should support the intervention performed.

Codes related to 43274

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

Codes related to 43274
CodeHow it relatesNational office range
Same family
43260ERCPDiagnostic ERCP code; 43274 includes therapeutic ductal stent placement.No office rate
43264ERCP extractionERCP code for ductal calculus removal, a distinct intervention from stent placement.No office rate
43277ERCP dilationERCP duct or ampulla dilation code; dilation associated with 43274 is included when performed as described.No office rate
Used instead
43276ERCP stent exchangeUse for removal and exchange of a biliary or pancreatic duct stent rather than initial placement.No office rate
43266Endoscopic stentReports endoscopic stent placement in the upper GI tract, not a biliary or pancreatic duct.No office rate

43274 billing questions

How does 43274 differ from 43276?

43274 reports placement of a stent in a biliary or pancreatic duct. 43276 applies when a ductal stent is removed and exchanged.

Is sphincterotomy separately reported with 43274?

Sphincterotomy is included when performed as part of the stent-placement service. The same applies to guidewire passage and pre- or post-dilation.

Can modifier 50 be used for stents in both ducts?

No. Medicare's bilateral adjustment does not apply to 43274, and modifier 50 is inappropriate for this code.

What documentation supports reporting 43274?

Document the indication for ductal drainage, the biliary or pancreatic duct treated, and the stent placement. Record related maneuvers performed during the ERCP.

What happens when another related endoscopy is performed in the same session?

CMS endoscopy family pricing applies when related endoscopies are performed together. Same-day preoperative and postoperative care is included under the 0-day global period.

Can an assistant or co-surgeon be billed for this procedure?

Medicare does not pay an assistant at surgery for 43274. 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 43274PPRRVU2026_Oct_nonQPP.csv, line 5,198 (RVU26D)

Open CMS sourceHow we calculate rates

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