Billing code 43275: ERCP removalMedicare rate & RVUs in Florida
During ERCP, report this service to retrieve a stent or other foreign material from a biliary or pancreatic duct without exchanging it.
CMS doesn’t publish an office rate for 43275 in Florida.
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 9 sections
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 in Florida
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
| Payment locality | Office | Facility |
|---|---|---|
| Fort Lauderdale | Unavailable | $349.88 |
| Miami | Unavailable | $370.40 |
| Rest Of Florida | Unavailable | $337.60 |
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
Work6.69
6.69 RVUs× 1.000 GPCI
Practice expense2.38
2.38 RVUs× 1.000 GPCI
Malpractice0.76
0.76 RVUs× 1.000 GPCI
Adjusted RVUs
9.8300
Conversion factor
$33.4009
Medicare rate
$328.33
Every GPCI starts 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
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 000 | Same-day global: pre- and post-op care on the day of the procedure is included. |
| Multiple procedures | 3 | Endoscopy family rules apply. |
| Bilateral (modifier 50) | 0 | The 150% bilateral adjustment doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 1 | Not paid (statutory restriction). |
| Co-surgeons (62) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician 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%).
43275 compared with similar codes
Compare codes · National
4 codes, side by side
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.
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
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