No office rate
Choose 43274 for ductal stent placement. Choose 43276 when an existing ductal stent is removed and exchanged.
On this page
CMS RVU26D · Effective 2026-10-01
43274 ERCP stenting Medicare reimbursement rates in Idaho
Reports endoscopic placement of a stent in a bile or pancreatic duct during ERCP, including related guidewire passage and specified accompanying maneuvers. Compare 43274 office and facility rates across CMS payment localities in Idaho.
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 43274 in Idaho?
Idaho 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
$378.34
1 of 1 localities have a supported rate.
Payment area: Idaho
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.
Gastroenterology
About 43274: ERCP duct stent placement
Reports endoscopic placement of a stent in a bile or pancreatic duct during ERCP, including related guidewire passage and specified accompanying maneuvers.
During ERCP, a gastroenterologist advances a side-viewing endoscope through the mouth to the duodenum, accesses the biliary or pancreatic duct, and places a stent to maintain drainage or passage. Typical situations include duct narrowing, obstruction, or a leak requiring endoscopic drainage. The service is most often performed in a hospital or ambulatory endoscopy facility.
Report 43274 when the procedure includes ductal stent placement. The operative report should identify the duct treated, the reason for stenting, and the placement performed. Guidewire passage, pre- or post-dilation, and sphincterotomy are included when performed as part of this service. The code has 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 for this code; Medicare also does not pay an assistant at surgery, co-surgeons, or a surgical team for it.
CMS billing rules for 43274
- 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 RVU8.27 · 69%
- Practice expense (office) RVU2.85 · 24%
- Malpractice RVU0.92 · 8%
40.8K
Medicare services in 2024 · #863 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.
43274 compared with similar codes
Office rates for Idaho, from the same CMS release.
No office rate
43266 describes endoscopic stent placement in the upper GI tract. 43274 is for placement in a biliary or pancreatic duct during ERCP.
No office rate
43264 reports ERCP removal of ductal calculi; 43274 reports ductal stent placement. The operative report should support the intervention performed.
Compare 43274 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
Idaho →
Office / nonfacility
Unavailable
Facility
$378.34
Need rates for a whole code list?
Fee-sheet and API access are in early access. Tell us which codes and locations your team needs.
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 43274 in Idaho.
PPRRVU2026_Oct_nonQPP.csv
5,198
- Code
- 43274
- Physician work
- 8.27
- Practice expense
- 2.85
- Malpractice
- 0.92
GPCI2026.csv
47
- Locality
- Idaho
- Physician work
- 1.000
- Practice expense
- 0.920
- Malpractice
- 0.473
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 8.27 | × 1.000 | 8.2700 |
| Practice expense | 2.85 | × 0.920 | 2.6220 |
| Malpractice | 0.92 | × 0.473 | 0.4352 |
| Total RVUs | 11.3272 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Idaho$378.34
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 8.27 | 1 |
| Practice expense | 2.85 | 0.92 |
| Malpractice | 0.92 | 0.473 |
(8.27 × 1 + 2.85 × 0.92 + 0.92 × 0.473) × $33.4009 = $378.34
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.
43274 billing questions
How does 43274 differ from 43276?
43274 reports placement of a stent in a biliary or pancreatic duct. 43276 applies when a ductal stent is removed and exchanged.
Is sphincterotomy separately reported with 43274?
Sphincterotomy is included when performed as part of the stent-placement service. The same applies to guidewire passage and pre- or post-dilation.
Can modifier 50 be used for stents in both ducts?
No. Medicare's bilateral adjustment does not apply to 43274, and modifier 50 is inappropriate for this code.
What documentation supports reporting 43274?
Document the indication for ductal drainage, the biliary or pancreatic duct treated, and the stent placement. Record related maneuvers performed during the ERCP.
What happens when another related endoscopy is performed in the same session?
CMS endoscopy family pricing applies when related endoscopies are performed together. Same-day preoperative and postoperative care is included under the 0-day global period.
Can an assistant or co-surgeon be billed for this procedure?
Medicare does not pay an assistant at surgery for 43274. Co-surgeons and team surgery are 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.
5,1954326F,,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
5,19643270,,Egd lesion ablation,A,,3.91,19.68,,1.57,,0.44,24.03,5.92,0,000,0.00,0.00,0.00,3,0,1,0,0,9,43235,33.4009,09,0,99,0.00,0.00,0.00
5,19743273,,Endoscopic pancreatoscopy,A,,2.18,0.64,NA,0.64,,0.23,3.05,3.05,0,ZZZ,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,19843274,,Ercp duct stent placement,A,,8.27,2.85,NA,2.85,,0.92,12.04,12.04,0,000,0.00,0.00,0.00,3,0,1,0,0,9,43260,33.4009,09,0,99,0.00,0.00,0.00
5,19943275,,Ercp remove forgn body duct,A,,6.69,2.38,NA,2.38,,0.76,9.83,9.83,0,000,0.00,0.00,0.00,3,0,1,0,0,9,43260,33.4009,09,0,99,0.00,0.00,0.00
5,20043276,,Ercp stent exchange w/dilate,A,,8.62,2.95,NA,2.95,,0.98,12.55,12.55,0,000,0.00,0.00,0.00,3,0,1,0,0,9,43260,33.4009,09,0,99,0.00,0.00,0.00
5,20143277,,Ercp ea duct/ampulla dilate,A,,6.73,2.40,NA,2.40,,0.75,9.88,9.88,0,000,0.00,0.00,0.00,3,0,1,0,0,9,43260,33.4009,09,0,99,0.00,0.00,0.00
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
5006102,IL,15,SUBURBAN CHICAGO,1.007,1.027,1.772