No office rate
43264 represents extraction of stones or debris. Choose 43265 when the endoscopist fragments or destroys calculi during ERCP.
On this page
CMS RVU26D · Effective 2026-10-01
43264 ERCP extraction Medicare reimbursement rates in Georgia
Report this ERCP therapeutic service when an endoscopist extracts stones or debris from a biliary or pancreatic duct without fragmenting them. Compare 43264 office and facility rates across CMS payment localities in Georgia.
Amounts below use the non-QP conversion factor for participating physicians. These are base physician payments before claim-level adjustments, not patient costs or total hospital charges.
What does Medicare pay for 43264 in Georgia?
Georgia has 2 payment localities in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the 2 payment areas shown below, using the same CMS release.
Office / nonfacility
No supported rate
Facility setting
$313.56–$324.03
2 of 2 localities have a supported rate.
These are locality ranges, not averages or address-specific quotes. A facility-setting amount covers the physician service; it does not include a hospital’s separate bill. Choose a locality below to inspect its calculation, compare other payment areas, or price a percentage of Medicare.
ERCP procedures
About 43264: ERCP duct stone or debris extraction
Report this ERCP therapeutic service when an endoscopist extracts stones or debris from a biliary or pancreatic duct without fragmenting them.
During ERCP, a gastroenterologist or other qualified endoscopist passes a side-viewing endoscope through the mouth to the duodenum, accesses the biliary or pancreatic duct, and retrieves calculi or debris, commonly with a balloon or basket. Typical cases include removing common bile duct stones in a patient with choledocholithiasis or clearing ductal debris. The service is performed in settings such as a hospital or ambulatory surgery center.
Report this code when the documented work includes ductal stone or debris extraction; use the distinct lithotripsy service when calculi are fragmented. The record should identify the treated duct and describe the retrieval performed. 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. Modifier 50 is inappropriate. Medicare does not pay an assistant at surgery for this service, and co-surgeon and team-surgery billing are not permitted.
CMS billing rules for 43264
- Global period
- Minor procedure with a 0-day global period: same-day preoperative and postoperative care is included.
- Multiple procedures
- Endoscopy family pricing applies when related endoscopies are performed together.
- Bilateral procedures
- Bilateral adjustment does not apply; the descriptor or anatomy makes modifier 50 inappropriate.
- Assistant at surgery
- Statutory restriction: assistant at surgery is not paid.
- Co-surgeons
- Co-surgeons not permitted.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU6.46 · 68%
- Practice expense (office) RVU2.32 · 24%
- Malpractice RVU0.72 · 8%
55.4K
Medicare services in 2024 · #745 by national volume
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.
43264 compared with similar codes
Office rates for Georgia, from the same CMS release.
Compare 43264 by payment locality
Find the payment area for your service address, then open its rate page for calculation inputs, release history and the percentage-of-Medicare tool. A city may cross payment-area boundaries; the ZIP lookup above helps resolve the location.
2 of 2 payment localities
Atlanta →
Office / nonfacility
Unavailable
Facility
$324.03
Rest Of Georgia →
Office / nonfacility
Unavailable
Facility
$313.56
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43264 billing questions
How does this differ from ERCP lithotripsy?
Use this code for extracting stones or debris without fragmentation. When the endoscopist destroys or fragments calculi, compare the service with 43265.
What documentation supports reporting this service?
Document the biliary or pancreatic duct treated, the presence of calculi or debris, and the extraction performed, such as retrieval with a balloon or basket.
Can modifier 50 be used for stones in two ducts?
No. CMS identifies bilateral adjustment as inappropriate for this code; the anatomy and descriptor do not support modifier 50.
How are related ERCP services priced on the same date?
When related endoscopies are performed together, CMS applies endoscopy family pricing rather than treating each service as an unrelated endoscopy for payment.
Is same-day postoperative care included?
Yes. The 0-day global period includes same-day preoperative and postoperative care.
Where these rates come from
FeeBase calculates base physician payments from CMS work, practice-expense, and malpractice RVUs, adjusted by each locality’s geographic indices and the applicable conversion factor. Unavailable or separately priced services are labeled rather than assigned a made-up amount.
Source: RVU26D. Effective 2026-10-01 through the day before 2027-01-01.
5,18943261,,Endo cholangiopancreatograph,A,,6.00,2.18,NA,2.18,,0.67,8.85,8.85,0,000,0.00,0.00,0.00,3,0,1,0,0,9,43260,33.4009,09,0,99,0.00,0.00,0.00
5,19043262,,Endo cholangiopancreatograph,A,,6.34,2.28,NA,2.28,,0.70,9.32,9.32,0,000,0.00,0.00,0.00,3,0,1,0,0,9,43260,33.4009,09,0,99,0.00,0.00,0.00
5,19143263,,Ercp sphincter pressure meas,A,,6.34,2.30,NA,2.30,,0.70,9.34,9.34,0,000,0.00,0.00,0.00,3,0,1,0,0,9,43260,33.4009,09,0,99,0.00,0.00,0.00
5,19243264,,Ercp remove duct calculi,A,,6.46,2.32,NA,2.32,,0.72,9.50,9.50,0,000,0.00,0.00,0.00,3,0,1,0,0,9,43260,33.4009,09,0,99,0.00,0.00,0.00
5,19343265,,Ercp lithotripsy calculi,A,,7.73,2.68,NA,2.68,,0.87,11.28,11.28,0,000,0.00,0.00,0.00,3,0,1,0,0,9,43260,33.4009,09,0,99,0.00,0.00,0.00
5,19443266,,Egd endoscopic stent place,A,,3.82,1.46,NA,1.46,,0.48,5.76,5.76,0,000,0.00,0.00,0.00,3,0,1,0,0,9,43235,33.4009,09,0,99,0.00,0.00,0.00
5,1954326F,,Pt asked re symp auto dysfxn,I,,0.00,0.00,,0.00,,0.00,0.00,0.00,9,XXX,0.00,0.00,0.00,9,9,9,9,9,9,,33.4009,09,0,99,0.00,0.00,0.00