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Billing code 43276: ERCP stent exchangeMedicare rate & RVUs

Reports ERCP removal and exchange of a biliary or pancreatic duct stent, including dilation performed to facilitate the exchange.

CMS RVU26DEffective Oct 1, 2026109 payment localities17.1K Medicare services in 2024

Medicare pays $419.18 for 43276 nationally in a facility.

Medicare rate · 43276

ERCP stent exchange

Work RVUs
8.62
Total RVUs
12.55
Global days
000

National rate · 2026

$419.18

Facility setting, before claim adjustments.

See every locality for 43276 →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 43276 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 43276 covers

During ERCP, a gastroenterologist advances an endoscope through the mouth into the duodenum to reach a biliary or pancreatic duct. This service covers removing an existing duct stent and exchanging it for a replacement; dilation may be performed as part of that work. Exchanges may be needed when a stent is obstructed or has migrated, or as part of ongoing management of a duct stricture. ERCP is generally performed in a hospital or ambulatory endoscopy setting.

Report the service for each stent exchanged, and document the duct, stent removal and replacement, and any dilation performed. Dilation included in the exchange is not a separate service for that same work. When related endoscopies are performed together, CMS endoscopy-family pricing applies. The procedure has a 0-day global period, so same-day preoperative and postoperative care is included. Modifier 50 is inappropriate for this anatomy and descriptor. Medicare does not pay an assistant at surgery for this service; 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 43276 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

43276 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$392.66
Alaska*Unavailable$554.85
ArizonaUnavailable$411.41
ArkansasUnavailable$389.41
AtlantaUnavailable$428.20
AustinUnavailable$421.74
BakersfieldUnavailable$421.31
Baltimore/Surr. CntysUnavailable$438.74
BeaumontUnavailable$407.99
BrazoriaUnavailable$413.40

43276 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
43276 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 43276 rate is calculated

Each of 43276’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 · 43276

RVUs × geographic indexes × conversion factor

Work8.62

8.62 RVUs× 1.000 GPCI

Practice expense2.95

2.95 RVUs× 1.000 GPCI

Malpractice0.98

0.98 RVUs× 1.000 GPCI

Adjusted RVUs

12.5500

Conversion factor

$33.4009

Medicare rate

$419.18

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

Payment rules and modifiers for 43276

The CMS indicators that decide how 43276 is paid alongside other services.

CMS payment indicators · 43276

ERCP stent exchange

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

43276 without 51 · national facility

$419.18

ERCP stent exchange

43276-51 · Second procedure: 50%

$209.59

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

43276 compared with similar codes

Compare codes · National

4 codes, side by side

  • 43276

    ERCP stent exchange8.62 wRVU

    Not priced

  • 43274

    ERCP stenting8.27 wRVU

    Not priced

  • 43275

    ERCP removal6.69 wRVU

    Not priced

  • 43277

    ERCP dilation6.73 wRVU

    Not priced

How to choose

43274ERCP stenting
43274 is for placing a duct stent without exchanging an existing one. Choose 43276 when the procedure removes and replaces a stent.
43275ERCP removal
43275 describes removal without exchange. If a replacement stent is inserted, the exchange service is represented by 43276.
43277ERCP dilation
43277 describes duct or ampullary dilation. Dilation performed as part of the stent exchange is included in 43276, rather than separately reported for that same work.

Codes related to 43276

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

Codes related to 43276
CodeHow it relatesNational office range
Used instead
43274ERCP stentingUsed for duct stent placement when an existing stent is not being exchanged.No office rate
43275ERCP removalDescribes duct stent or foreign-body removal without replacement.No office rate
Same family
43277ERCP dilationERCP dilation service by duct or ampulla; dilation included in an exchange is not separately reported.No office rate
Often billed with
43264ERCP extractionMay describe distinct duct-stone extraction performed during the same ERCP.No office rate

43276 billing questions

When should 43276 be selected instead of 43274?

Use 43276 when an existing biliary or pancreatic duct stent is removed and exchanged. Code 43274 describes placement of a stent without the exchange service.

How is the number of units determined?

Report one unit for each stent exchanged. The record should identify the stents removed and replaced.

Can dilation be reported separately?

Dilation performed as part of the stent exchange is included. Document the duct and the work performed; do not separately report that same dilation as 43277.

Can 43275 be used when the stent is removed?

43275 describes removal without exchange. When the existing stent is removed and replaced, 43276 represents the exchange service.

Does modifier 50 apply, or can an assistant be paid?

Modifier 50 is inappropriate for this code. Medicare does not pay an assistant at surgery for 43276.

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 43276PPRRVU2026_Oct_nonQPP.csv, line 5,200 (RVU26D)

Open CMS sourceHow we calculate rates

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