No office rate
43262 describes endoscopic sphincterotomy performed during ERCP; 47460 is for surgical incision of the biliary sphincter.
On this page
CMS RVU26D · Effective 2026-10-01
47460 Biliary sphincterotomy Medicare reimbursement rates in Iowa
Reports surgical incision of the biliary sphincter, such as during operative treatment of an obstruction at the distal bile duct outlet. Compare 47460 office and facility rates across CMS payment localities in Iowa.
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 47460 in Iowa?
Iowa 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
$1058.84
1 of 1 localities have a supported rate.
Payment area: Iowa
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 47460: Surgical biliary sphincterotomy
Reports surgical incision of the biliary sphincter, such as during operative treatment of an obstruction at the distal bile duct outlet.
This code represents a surgeon’s operative incision of the biliary sphincter, the outlet where bile passes into the intestine. It is distinct from an endoscopic sphincterotomy performed through an ERCP scope. A general or hepatobiliary surgeon may perform the surgical procedure in a hospital operating room when operative access to the sphincter is needed, for example, in treating an obstruction at the distal bile duct outlet.
Report the code when the operative record supports a surgical sphincter incision, rather than only a bile duct incision or an endoscopic procedure. Documentation should identify the operative approach, the sphincter treated, and the reason for the incision. CMS assigns a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. For multiple procedures in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% reduction. Modifier 50 is inappropriate for this code. An assistant at surgery may be paid; co-surgeon payment requires supporting documentation, and team surgery is not permitted.
CMS billing rules for 47460
- 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 RVU20.01 · 56%
- Practice expense (office) RVU10.46 · 29%
- Malpractice RVU5.34 · 15%
15
Medicare services in 2024 · #6075 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.
47460 compared with similar codes
Office rates for Iowa, from the same CMS release.
No office rate
47420 concerns incision of the bile duct, typically for duct exploration; 47460 targets the biliary sphincter.
No office rate
47425 is associated with bile duct incision and calculus removal. Choose 47460 when the documented surgical work is sphincter incision.
Compare 47460 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
Iowa →
Office / nonfacility
Unavailable
Facility
$1058.84
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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 47460 in Iowa.
PPRRVU2026_Oct_nonQPP.csv
5,680
- Code
- 47460
- Physician work
- 20.01
- Practice expense
- 10.46
- Malpractice
- 5.34
GPCI2026.csv
53
- Locality
- Iowa
- Physician work
- 1.000
- Practice expense
- 0.915
- Malpractice
- 0.397
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 20.01 | × 1.000 | 20.0100 |
| Practice expense | 10.46 | × 0.915 | 9.5709 |
| Malpractice | 5.34 | × 0.397 | 2.1200 |
| Total RVUs | 31.7009 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Iowa$1058.84
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 20.01 | 1 |
| Practice expense | 10.46 | 0.915 |
| Malpractice | 5.34 | 0.397 |
(20.01 × 1 + 10.46 × 0.915 + 5.34 × 0.397) × $33.4009 = $1058.84
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.
47460 billing questions
How is this different from endoscopic sphincterotomy?
This code is for a surgical approach to the biliary sphincter. For sphincterotomy performed endoscopically during ERCP, consider 43262.
When would a bile duct incision code be more appropriate?
Use a duct-incision code when the documented operation is directed at opening the bile duct for exploration or stone removal, rather than incising the sphincter.
Should modifier 50 be reported?
No. The anatomy and descriptor make bilateral reporting with modifier 50 inappropriate.
What global care is included?
The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.
Can an assistant or co-surgeon be reported?
An assistant at surgery may be paid. Co-surgeon payment requires supporting documentation, and CMS does not permit team-surgery reporting.
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.
5,67747400,,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
5,68247490,,Incision of gallbladder,A,,4.64,3.80,NA,3.80,,0.49,8.93,8.93,0,010,0.10,0.80,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,68347531,,Injection for cholangiogram,A,,1.27,10.52,,0.44,,0.14,11.93,1.85,0,000,0.00,0.00,0.00,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5006102,IL,15,SUBURBAN CHICAGO,1.007,1.027,1.772
5106102,IL,99,REST OF ILLINOIS,1.000,0.913,1.563
5208102,IN,00,INDIANA,1.000,0.927,0.486
5305102,IA,00,IOWA,1.000,0.915,0.397
5405202,KS,00,KANSAS,1.000,0.904,0.504
5515102,KY,00,KENTUCKY,1.000,0.889,0.915
5607202,LA,01,NEW ORLEANS,1.000,0.941,1.136