No office rate
43277 describes balloon dilation of a duct or ampulla; 43264 describes duct-stone extraction. The procedures may occur during the same ERCP when both are performed.
On this page
CMS RVU26D · Effective 2026-10-01
43277 ERCP dilation Medicare reimbursement rates in Michigan
ERCP balloon dilation enlarges a narrowed biliary or pancreatic duct, or the ampulla, and is reported for each treated duct during therapeutic endoscopy. Compare 43277 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 43277 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
$326.26–$344.38
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.
Gastrointestinal endoscopy
About 43277: ERCP duct or ampulla balloon dilation
ERCP balloon dilation enlarges a narrowed biliary or pancreatic duct, or the ampulla, and is reported for each treated duct during therapeutic endoscopy.
During ERCP, the endoscopist guides a balloon to a narrowed biliary or pancreatic duct, or the ampulla, and expands it to improve passage through the narrowed area. Gastroenterologists and other endoscopists with therapeutic ERCP expertise typically perform this in a hospital or ambulatory endoscopy facility. Common indications include a duct stricture or papillary narrowing. Sphincterotomy, when performed as part of the dilation service, is included.
Report the service for each duct treated; documentation should identify the duct or ampulla and the dilation performed. This is a minor procedure with a 0-day global period, so same-day preoperative and postoperative care is included. When related endoscopies are performed together, Medicare applies endoscopy family pricing rather than treating each service as unrelated. Modifier 50 is inappropriate for this anatomy and service. Medicare does not pay an assistant at surgery, and co-surgeons and team surgery are not permitted for this code.
CMS billing rules for 43277
- 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 RVU6.73 · 68%
- Practice expense (office) RVU2.40 · 24%
- Malpractice RVU0.75 · 8%
6K
Medicare services in 2024 · #1757 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.
43277 compared with similar codes
Office rates for Michigan, from the same CMS release.
No office rate
43276 applies when a duct stent is removed and exchanged, with dilation included when performed. Use 43277 for duct or ampulla dilation when stent exchange is not the service being described.
No office rate
43278 describes lesion ablation with dilation. 43277 describes dilation without that ablation service.
No office rate
43274 describes placement of a duct stent. 43277 describes balloon dilation; choose based on the documented intervention, not simply the presence of a duct narrowing.
Compare 43277 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
$344.38
Rest Of Michigan →
Office / nonfacility
Unavailable
Facility
$326.26
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43277 billing questions
How is 43277 distinguished from stone-removal ERCP?
Use 43277 for balloon dilation of a duct or the ampulla. When the documented intervention is duct-stone extraction, compare it with 43264; dilation alone does not describe extraction.
Can 43277 be reported for more than one duct?
The code is reported for each duct treated. Document the specific duct or ducts dilated and the work performed at each site.
Is sphincterotomy separately reported with 43277?
Sphincterotomy performed as part of the dilation is included. Do not separately report it as though it were an unrelated service.
Should modifier 50 be used for dilation on both sides?
No. CMS identifies bilateral adjustment as inappropriate for this code; the duct-based descriptor and anatomy do not call for modifier 50.
What same-day care is included in the global period?
The 0-day global period includes same-day preoperative and postoperative care. It does not extend the global period beyond the procedure date.
Can an assistant surgeon or co-surgeon be paid for 43277?
Medicare does not pay an assistant at surgery for this code. 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.
5,19843274,,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
5,20243278,,Ercp lesion ablate w/dilate,A,,7.72,2.68,NA,2.68,,0.87,11.27,11.27,0,000,0.00,0.00,0.00,3,0,1,0,0,9,43260,33.4009,09,0,99,0.00,0.00,0.00
5,20343279,,Lap myotomy heller,A,,21.55,8.79,NA,8.79,,5.58,35.92,35.92,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,20443280,,Laparoscopy fundoplasty,A,,17.65,8.05,NA,8.05,,4.60,30.30,30.30,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00