No office rate
Choose 47420 for bile-duct incision with exploration. Choose 47425 when the operative service includes removal of a calculus.
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CMS RVU26D · Effective 2026-10-01
47420 Bile duct surgery Medicare reimbursement rates in Guam
Reports operative incision of the bile duct for direct exploration, commonly when a surgeon evaluates suspected obstruction during abdominal surgery. Compare 47420 office and facility rates across CMS payment localities in Guam.
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 47420 in Guam?
Guam has 1 payment locality in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the payment area shown below, using the same CMS release.
Office / nonfacility
No supported rate
Facility setting
$1210.00
1 of 1 localities have a supported rate.
Payment area: Hawaii, Guam
One mapped payment locality.
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.
Biliary surgery
About 47420: Bile duct incision with exploration
Reports operative incision of the bile duct for direct exploration, commonly when a surgeon evaluates suspected obstruction during abdominal surgery.
This service involves surgically opening the bile duct so the surgeon can inspect or explore its lumen, often to investigate suspected stones or another obstruction. It is typically performed by a general or hepatobiliary surgeon in a hospital operating room as part of an abdominal operation. It is distinct from opening the gallbladder and from endoscopic treatment through the papilla.
Report the code when the operative note supports an actual bile-duct incision and exploration. Documentation should identify the duct involved, the reason for exploration, and the operative work performed; a note describing only gallbladder surgery or endoscopic duct treatment does not support this service. Medicare assigns a 90-day global period, including the day-before preoperative visit and related postoperative care during that period. When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and the others at 50%. An assistant at surgery may be paid; co-surgeon payment requires supporting documentation, and team surgery is not permitted. Modifier 50 is inappropriate for this single-duct procedure.
CMS billing rules for 47420
- Global period
- Major surgery with a 90-day global period: the day-before preoperative visit and 90 days of related postoperative care are included.
- Multiple procedures
- Standard multiple procedure reduction: the highest-valued procedure is paid in full and others at 50% when performed in the same session.
- Bilateral procedures
- Bilateral adjustment does not apply; the descriptor or anatomy makes modifier 50 inappropriate.
- Assistant at surgery
- Assistant at surgery may be paid.
- Co-surgeons
- Co-surgeons paid only with supporting documentation.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU21.48 · 58%
- Practice expense (office) RVU10.23 · 28%
- Malpractice RVU5.38 · 15%
189
Medicare services in 2024 · #4369 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.
47420 compared with similar codes
Office rates for Guam, from the same CMS release.
No office rate
47400 concerns hepatic ducts within the liver; 47420 concerns the bile duct outside the liver.
No office rate
47460 addresses incision or treatment of the biliary sphincter. This code is for an operative incision into the bile duct for exploration.
Compare 47420 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.
1 of 1 payment localities
Hawaii, Guam →
Office / nonfacility
Unavailable
Facility
$1210.00
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How this local rate is calculated
Each RVU component is multiplied by its own geographic practice cost index (GPCI). The three adjusted components are added, then multiplied by the conversion factor. These are the inputs used for 47420 in Hawaii, Guam.
PPRRVU2026_Oct_nonQPP.csv
5,678
- Code
- 47420
- Physician work
- 21.48
- Practice expense
- 10.23
- Malpractice
- 5.38
GPCI2026.csv
46
- Locality
- Hawaii, Guam
- Physician work
- 1.000
- Practice expense
- 1.137
- Malpractice
- 0.579
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 21.48 | × 1.000 | 21.4800 |
| Practice expense | 10.23 | × 1.137 | 11.6315 |
| Malpractice | 5.38 | × 0.579 | 3.1150 |
| Total RVUs | 36.2265 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Hawaii, Guam$1210.00
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 21.48 | 1 |
| Practice expense | 10.23 | 1.137 |
| Malpractice | 5.38 | 0.579 |
(21.48 × 1 + 10.23 × 1.137 + 5.38 × 0.579) × $33.4009 = $1210.00
The office and facility calculations use their respective practice-expense RVUs. The facility amount here is the physician fee, not a separate hospital or facility bill.
47420 billing questions
How is this distinguished from 47425?
This code describes bile-duct incision with exploration. Code 47425 is the related variant used when the documented operative service includes removal of a calculus.
Can this be reported for an endoscopic duct procedure?
No. This code represents operative incision and exploration of the bile duct, not endoscopic treatment such as an incision at the biliary sphincter.
What documentation supports reporting it?
The operative report should identify the bile duct opened, the reason for exploration, and the exploration performed. A general reference to biliary evaluation without an incision and exploration is not enough.
What postoperative care is included?
The 90-day global period includes the day-before preoperative visit and related postoperative care during the 90 days after surgery.
How are multiple procedures and surgical assistance handled?
In the same session, the highest-valued procedure is paid in full and other procedures are paid at 50%. An assistant may be paid; co-surgeon payment needs supporting documentation, while team surgery is not permitted.
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.
5,67547384,,Abltj ire liver 1+ tum perq,A,,9.41,2.17,NA,2.17,,1.12,12.70,12.70,0,000,0.00,0.00,0.00,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,67647399,,Unlisted procedure liver,C,,0.00,0.00,,0.00,,0.00,0.00,0.00,0,YYY,0.00,0.00,0.00,2,0,1,1,1,9,,33.4009,09,0,99,0.00,0.00,0.00
5,67747400,,Incision of liver duct,A,,35.45,14.74,NA,14.74,,9.49,59.68,59.68,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,67847420,,Incision of bile duct,A,,21.48,10.23,NA,10.23,,5.38,37.09,37.09,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,67947425,,Incision of bile duct,A,,21.75,10.89,NA,10.89,,5.82,38.46,38.46,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,68047460,,Incise bile duct sphincter,A,,20.01,10.46,NA,10.46,,5.34,35.81,35.81,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,68147480,,Incision of gallbladder,A,,12.92,8.98,NA,8.98,,3.18,25.08,25.08,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4309102,FL,99,REST OF FLORIDA,1.000,0.956,1.503
4410212,GA,01,ATLANTA,1.003,1.016,1.201
4510212,GA,99,REST OF GEORGIA,1.000,0.892,1.192
4601212,HI,01,"HAWAII, GUAM",1.000,1.137,0.579
4702202,ID,00,IDAHO,1.000,0.920,0.473
4806102,IL,16,CHICAGO,1.007,1.005,2.295
4906102,IL,12,EAST ST. LOUIS,1.000,0.920,2.014