No office rate
Use 43264 for removal of duct calculi or debris without lithotripsy; 43265 is for active stone destruction or fragmentation.
On this page
CMS RVU26D · Effective 2026-10-01
43265 ERCP lithotripsy Medicare reimbursement rates in Missouri
Reports endoscopic fragmentation of biliary or pancreatic duct stones during ERCP, such as when stones require lithotripsy rather than routine extraction alone. Compare 43265 office and facility rates across CMS payment localities in Missouri.
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 43265 in Missouri?
Missouri has 3 payment localities in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the 3 payment areas shown below, using the same CMS release.
Office / nonfacility
No supported rate
Facility setting
$363.65–$372.52
3 of 3 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 43265 pays more and less in Missouri
Gastrointestinal endoscopy
About 43265: ERCP duct stone lithotripsy
Reports endoscopic fragmentation of biliary or pancreatic duct stones during ERCP, such as when stones require lithotripsy rather than routine extraction alone.
During ERCP, an endoscope is advanced to the duodenum and instruments are passed into the biliary or pancreatic ducts to fragment calculi. A gastroenterologist or other trained endoscopist may use mechanical, electrohydraulic, or laser lithotripsy, often for stones that are difficult to remove intact. These procedures are generally performed in a hospital or ambulatory surgery center.
Report this service when the endoscopist documents active destruction or fragmentation of duct calculi, including the treated duct and method when available. Distinguish it from code 43264 when the service is duct-stone removal without lithotripsy. The CMS 0-day global period includes same-day preoperative and postoperative care. When related endoscopies are performed together, endoscopy family pricing applies. Modifier 50 is inappropriate for this descriptor and anatomy. Medicare does not pay an assistant at surgery for this service; co-surgeons and team surgery are not permitted.
CMS billing rules for 43265
- 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 RVU7.73 · 69%
- Practice expense (office) RVU2.68 · 24%
- Malpractice RVU0.87 · 8%
2.1K
Medicare services in 2024 · #2419 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.
43265 compared with similar codes
Office rates for Missouri, from the same CMS release.
No office rate
43262 reports sphincterotomy or papillotomy during ERCP. It does not describe fragmentation of duct calculi.
No office rate
43274 describes placing a stent in a biliary or pancreatic duct; 43265 describes calculus fragmentation.
Compare 43265 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.
3 of 3 payment localities
Metropolitan Kansas City →
Office / nonfacility
Unavailable
Facility
$370.63
Metropolitan St. Louis →
Office / nonfacility
Unavailable
Facility
$372.52
Rest Of Missouri →
Office / nonfacility
Unavailable
Facility
$363.65
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43265 billing questions
Can stone extraction also be reported after lithotripsy?
Document which services were performed, but do not assume that retrieval of fragmented stones supports a separate code. Related endoscopies performed together are subject to CMS endoscopy family pricing.
Does modifier 50 apply when more than one duct is treated?
No. CMS identifies bilateral adjustment as inapplicable because the descriptor or anatomy makes modifier 50 inappropriate.
What documentation supports reporting 43265?
Document ERCP, the duct and calculi treated, and the lithotripsy or other destruction method. The record should distinguish fragmentation from extraction alone.
Can an assistant surgeon or co-surgeon be paid for 43265?
Medicare does not pay an assistant at surgery for this code. Co-surgeons and team surgery are not permitted.
What does the 0-day global period include?
Same-day preoperative and postoperative care is included in the procedure's payment.
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.
5,19043262,,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
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