CPT code 43278: ERCP ablation2026 Medicare rate & RVUs

Medicare pays $376.43 for 43278 nationally in a facility.

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.

Where 43278 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

43278 rates by state

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

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

43278 compared with similar codes

How to choose

43277ERCP dilation

43278 requires ablation of a ductal lesion; 43277 describes ERCP dilation without that defining ablation service.

43270Lesion ablation

43270 is ablation by upper endoscopy for a luminal upper-GI lesion. Use 43278 for ablation of a lesion accessed within a bile or pancreatic duct by ERCP.

43276ERCP stent exchange

43276 concerns ERCP stent exchange with dilation. Choose 43278 when the treated service is ductal lesion ablation, not stent exchange.

43265ERCP lithotripsy

43265 addresses duct stones using lithotripsy. It is not the lesion-ablation service reported with 43278.

Codes related to 43278

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

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