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Billing code 43275: ERCP removalMedicare rate & RVUs

During ERCP, report this service to retrieve a stent or other foreign material from a biliary or pancreatic duct without exchanging it.

CMS RVU26DEffective Oct 1, 2026109 payment localities13.7K Medicare services in 2024

Medicare pays $328.33 for 43275 nationally in a facility.

Medicare rate · 43275

ERCP removal

Swap in your local Medicare rate.

Work RVUs
6.69
Total RVUs
9.83
Global days
000

National rate · 2026

$328.33

Facility setting, before claim adjustments.

See every locality for 43275 → · 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 43275 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 43275 covers

During endoscopic retrograde cholangiopancreatography (ERCP), a therapeutic endoscopist uses a duodenoscope and retrieval tools to remove a stent or other foreign material from a bile duct or pancreatic duct. Common situations include removal of a retained or migrated duct stent. The service is performed in an endoscopy suite or hospital procedure room, generally by a gastroenterologist experienced in therapeutic ERCP.

Report the service when the duct foreign body or stent is actually removed; document the item, duct, and removal. If a stent is exchanged for another, distinguish that service from removal alone. Duct stones or debris are addressed by a different ERCP service. CMS assigns a 0-day global period, so same-day preoperative and postoperative care is included. Endoscopy family pricing applies when related endoscopies are performed together. Modifier 50 is inappropriate. Medicare does not pay an assistant at surgery for this service, and 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 43275 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

43275 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$307.38
Alaska*Unavailable$433.83
ArizonaUnavailable$322.21
ArkansasUnavailable$304.81
AtlantaUnavailable$335.38
AustinUnavailable$330.49
BakersfieldUnavailable$330.28
Baltimore/Surr. CntysUnavailable$343.73
BeaumontUnavailable$319.37
BrazoriaUnavailable$323.82

43275 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
43275 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 43275 rate is calculated

Each of 43275’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 · 43275

RVUs × geographic indexes × conversion factor

Swap in your local Medicare rate.

Work 6.69Practice expense 2.38Malpractice 0.76

9.8300 adjusted RVUs×$33.4009 conversion factor=$328.33

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

Payment rules and modifiers for 43275

The CMS indicators that decide how 43275 is paid alongside other services.

CMS payment indicators · 43275

ERCP removal

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

43275 without 51 · national facility

$328.33

ERCP removal

43275-51 · Second procedure: 50%

$164.17

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

43275 compared with similar codes

Compare codes

43275 vs 43276 vs 43264 vs 43274: national Medicare rates

Swap in your local Medicare rate.

  • 43275
    ERCP removal · 6.69 wRVU
    —
  • 43276
    ERCP stent exchange · 8.62 wRVU
    —
  • 43264
    ERCP extraction · 6.46 wRVU
    —
  • 43274
    ERCP stenting · 8.27 wRVU
    —

How to choose

43276ERCP stent exchange
43275 reports removal without stent exchange. 43276 applies when a stent is removed and exchanged for another.
43264ERCP extraction
43264 describes ERCP removal of duct calculi or debris. Use 43275 for a stent or other foreign body.
43274ERCP stenting
43274 is for ERCP duct stent placement. It does not describe retrieval of an existing stent or foreign body.

Codes related to 43275

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

Codes related to 43275
CodeHow it relatesNational office range
Used instead
43276ERCP stent exchangeUse for stent removal with exchange rather than removal alone.No office rate
43274ERCP stentingCovers duct stent placement when no stent or foreign body is removed.No office rate
43264ERCP extractionFor ERCP extraction of duct calculi or debris rather than a stent or foreign body.No office rate
43265ERCP lithotripsyFor ERCP lithotripsy of duct calculi, not retrieval of a stent or foreign body.No office rate

43275 billing questions

When should 43275 be chosen instead of 43276?

Use 43275 for removal of a duct stent or other foreign body without stent exchange. Use 43276 when a stent is removed and exchanged for another.

Can 43275 be used to report removal of duct stones?

No. For extraction of duct calculi or debris, consider 43264; 43275 describes removal of a stent or other foreign body.

What documentation supports reporting 43275?

The ERCP report should identify the duct and the stent or foreign material removed, and describe the retrieval performed. Document whether a stent was exchanged.

Should modifier 50 be appended for removal from two ducts?

No. CMS identifies bilateral adjustment as inappropriate for this service. Document the duct or ducts treated.

How does the 0-day global period affect same-day care?

Same-day preoperative and postoperative care is included in the procedure's global period. Related endoscopies performed together are subject to CMS endoscopy family pricing.

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 43275PPRRVU2026_Oct_nonQPP.csv, line 5,199 (RVU26D)

Open CMS sourceHow we calculate rates

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