No office rate
This code requires sphincter pressure measurement. Use 43260 for diagnostic ERCP without manometry.
On this page
CMS RVU26D · Effective 2026-10-01
43263 ERCP manometry Medicare reimbursement rates in Illinois
Report this service when an endoscopist performs sphincter of Oddi pressure measurements during ERCP to evaluate suspected biliary or pancreatic outflow dysfunction. Compare 43263 office and facility rates across CMS payment localities in Illinois.
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 43263 in Illinois?
Illinois has 4 payment localities in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the 4 payment areas shown below, using the same CMS release.
Office / nonfacility
No supported rate
Facility setting
$318.44–$344.11
4 of 4 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.
Where 43263 pays more and less in Illinois
Gastroenterology
About 43263: ERCP with sphincter pressure measurement
Report this service when an endoscopist performs sphincter of Oddi pressure measurements during ERCP to evaluate suspected biliary or pancreatic outflow dysfunction.
During ERCP, the endoscopist uses a manometry catheter to measure pressure at the sphincter of Oddi, which regulates bile and pancreatic juice flow into the duodenum. Gastroenterologists typically perform the study in a hospital or ambulatory endoscopy setting, often when evaluating suspected sphincter-related outflow problems. The service involves actual pressure measurement; ERCP imaging or cannulation alone does not support reporting it.
Select this code when the procedure record documents sphincter pressure measurements, the anatomy assessed, and relevant findings. The ERCP access and pressure study are represented together, so do not separately report a diagnostic ERCP code for the same service. CMS assigns a 0-day global period, including same-day preoperative and postoperative care. When related endoscopies are performed together, CMS applies endoscopy-family pricing. Modifier 50 is inappropriate for this code. Medicare does not pay an assistant at surgery, and co-surgeons and team surgery are not permitted.
CMS billing rules for 43263
- 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 RVU6.34 · 68%
- Practice expense (office) RVU2.30 · 25%
- Malpractice RVU0.70 · 7%
19
Medicare services in 2024 · #5947 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.
43263 compared with similar codes
Office rates for Illinois, from the same CMS release.
No office rate
This code reports sphincter pressure measurement; 43262 reports therapeutic papillary sphincterotomy.
No office rate
This code covers pressure measurement, while 43264 covers endoscopic removal of duct calculi.
Compare 43263 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.
4 of 4 payment localities
Chicago →
Office / nonfacility
Unavailable
Facility
$344.11
East St. Louis →
Office / nonfacility
Unavailable
Facility
$329.53
Rest Of Illinois →
Office / nonfacility
Unavailable
Facility
$318.44
Suburban Chicago →
Office / nonfacility
Unavailable
Facility
$333.57
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.
43263 billing questions
When should this code be chosen instead of a diagnostic ERCP code?
Choose it when sphincter of Oddi pressure is actually measured during ERCP. A diagnostic ERCP without manometry does not support this code.
Can the diagnostic ERCP be reported separately for the same procedure?
The pressure-measurement service includes ERCP, so do not separately report a diagnostic ERCP code for the same access and study.
What documentation supports reporting this service?
The procedure report should identify the sphincter pressure measurements performed, the anatomy assessed, and the findings. ERCP imaging or cannulation alone is not enough.
How does CMS price it with another endoscopy?
When related endoscopies are performed together, CMS applies endoscopy-family pricing. The same-day preoperative and postoperative care is included under the 0-day global period.
Can modifier 50 or an assistant-at-surgery claim be used?
Modifier 50 is inappropriate for this code. Medicare does not pay an assistant at surgery for the service.
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.
5,18843260,,Ercp w/specimen collection,A,,5.70,2.09,NA,2.09,,0.62,8.41,8.41,0,000,0.00,0.00,0.00,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,18943261,,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