Billing code 43278: ERCP ablationMedicare rate & RVUs in Florida
Reports ERCP treatment that ablates a lesion in a bile or pancreatic duct, including associated guidewire passage and dilation when performed.
CMS doesn’t publish an office rate for 43278 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 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 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 | $401.07 |
| Miami | Unavailable | $424.53 |
| Rest Of Florida | Unavailable | $387.11 |
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.
How the rate is built · 43278
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 7.72Practice expense 2.68Malpractice 0.87
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 43278
The CMS indicators that decide how 43278 is paid alongside other services.
CMS payment indicators · 43278
ERCP ablation
| 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
43278 without 51 · national facility
$376.43
ERCP ablation
43278-51 · Second procedure: 50%
$188.22
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%).
43278 compared with similar codes
Compare codes
43278 vs 43277 vs 43270 vs 43276 vs 43265: national Medicare rates
Swap in your local Medicare rate.
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.
43278 billing questions
How is this different from ERCP dilation code 43277?
Report 43278 when the ERCP includes ablation of a ductal lesion. Use 43277 for qualifying duct or ampulla dilation when lesion ablation is not performed.
Is dilation separately reported with 43278?
Pre- or post-ablation dilation and guidewire passage are included when performed as part of the lesion-ablation service.
Can 43278 be reported with another endoscopy on the same date?
Related endoscopies performed together are subject to endoscopy family pricing. Document each service performed; CMS payment follows that pricing rule.
What documentation supports reporting 43278?
The ERCP report should identify the bile or pancreatic duct lesion treated and describe the ablation. Include any dilation performed and the duct involved.
Can an assistant surgeon or co-surgeon be paid for this procedure?
CMS does not pay an assistant at surgery for 43278. Co-surgeons and team surgery are not permitted.
Does this code have a postoperative global period?
It has a 0-day global period. Same-day preoperative and postoperative care is included.
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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