No office rate
43260 describes ERCP with specimen collection. Choose 43262 when the endoscopist performs a sphincter incision.
On this page
CMS RVU26D · Effective 2026-10-01
43262 ERCP sphincterotomy Medicare reimbursement rates in Michigan
Reports ERCP in which the endoscopist makes a sphincter incision, commonly to improve duct drainage or enable treatment of biliary stones. Compare 43262 office and facility rates across CMS payment localities in Michigan.
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 43262 in Michigan?
Michigan 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
$307.69–$324.67
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.
Gastroenterology
About 43262: ERCP with biliary or pancreatic sphincterotomy
Reports ERCP in which the endoscopist makes a sphincter incision, commonly to improve duct drainage or enable treatment of biliary stones.
During ERCP, a gastroenterologist advances an endoscope to the major papilla and uses an endoscopic cutting instrument to incise the biliary or pancreatic sphincter. The opening can facilitate duct drainage or allow treatment such as removing common bile duct stones. This service is generally performed in a hospital or ambulatory endoscopy setting when imaging or other evaluation indicates a need for therapeutic duct access, including biliary obstruction or choledocholithiasis.
Report this code when the procedure record supports that a sphincterotomy or papillotomy was actually performed, not merely planned or considered. Document the indication, the site of the incision, and the therapeutic work completed. The code has a 0-day global period, so same-day preoperative and postoperative care is included. When related endoscopies are performed together, CMS endoscopy family pricing applies. Modifier 50 is inappropriate; an assistant at surgery is not paid under the statutory restriction, and co-surgeon and team-surgery payment are not permitted.
CMS billing rules for 43262
- 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) RVU2.28 · 24%
- Malpractice RVU0.70 · 8%
23.5K
Medicare services in 2024 · #1077 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.
43262 compared with similar codes
Office rates for Michigan, from the same CMS release.
No office rate
43261 is the ERCP code for biopsy. A biopsy is distinct from the sphincter incision reported with 43262.
No office rate
43263 reports ERCP with sphincter pressure measurement. It does not describe the incision that distinguishes 43262.
No office rate
43264 reports removal of duct calculi. Use 43262 for the sphincterotomy itself; both services may be performed during the same ERCP.
Compare 43262 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
Detroit →
Office / nonfacility
Unavailable
Facility
$324.67
Rest Of Michigan →
Office / nonfacility
Unavailable
Facility
$307.69
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43262 billing questions
How does this differ from 43260?
Use 43262 when the ERCP includes a sphincterotomy or papillotomy. Code 43260 describes an ERCP with specimen collection rather than this sphincter incision.
Can duct stone removal be reported with this code?
Code 43264 describes duct calculus removal and may be reported for that work when both procedures are performed. The operative report should make the sphincterotomy and stone-removal services clear.
What documentation supports reporting 43262?
The ERCP report should identify the clinical indication and document that the endoscopist performed an incision of the biliary or pancreatic sphincter.
Should modifier 50 be appended?
No. CMS identifies bilateral adjustment as inapplicable to this code, so modifier 50 is inappropriate.
Is same-day postoperative care separately included?
No. 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.
5,1874325F,,Med txmnt options rvwd w/pt,M,,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
5,18843260,,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