No office rate
43278 requires ablation of a ductal lesion; 43277 describes ERCP dilation without that defining ablation service.
On this page
CMS RVU26D · Effective 2026-10-01
43278 ERCP ablation Medicare reimbursement rates in Missouri
Reports ERCP treatment that ablates a lesion in a bile or pancreatic duct, including associated guidewire passage and dilation when performed. Compare 43278 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 43278 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
$363.32–$372.19
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 43278 pays more and less in Missouri
Gastroenterology
About 43278: ERCP duct lesion ablation
Reports ERCP treatment that ablates a lesion in a bile or pancreatic duct, including associated guidewire passage and dilation when performed.
During ERCP, the endoscopist advances an endoscope to the duodenum, accesses the biliary or pancreatic duct, and ablates a ductal tumor, polyp, or other lesion. The service is typically performed by a gastroenterologist in a hospital or endoscopy facility, often to treat an intraductal lesion identified during evaluation or treatment of a duct abnormality. Guidewire passage and pre- or post-ablation dilation are included when performed; dilation alone is not the defining service.
Select this code when the documented ERCP includes ablation of a ductal lesion, rather than dilation alone, stone removal, or stent work without lesion ablation. The procedure note should identify the treated duct and lesion, describe the ablation performed, and record any associated dilation. CMS assigns a 0-day global period, so same-day preoperative and postoperative care is included. When related endoscopies are performed together, endoscopy family pricing applies. Medicare does not pay an assistant at surgery for this code; co-surgeons and team surgery are not permitted.
CMS billing rules for 43278
- 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 RVU7.72 · 69%
- Practice expense (office) RVU2.68 · 24%
- Malpractice RVU0.87 · 8%
436
Medicare services in 2024 · #3663 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.
43278 compared with similar codes
Office rates for Missouri, from the same CMS release.
$711.53–$771.10
43270 is ablation by upper endoscopy for a luminal upper-GI lesion. Use 43278 for ablation of a lesion accessed within a bile or pancreatic duct by ERCP.
No office rate
43276 concerns ERCP stent exchange with dilation. Choose 43278 when the treated service is ductal lesion ablation, not stent exchange.
No office rate
43265 addresses duct stones using lithotripsy. It is not the lesion-ablation service reported with 43278.
Compare 43278 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
$370.30
Metropolitan St. Louis →
Office / nonfacility
Unavailable
Facility
$372.19
Rest Of Missouri →
Office / nonfacility
Unavailable
Facility
$363.32
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43278 billing questions
How is this different from ERCP dilation code 43277?
Report 43278 when the ERCP includes ablation of a ductal lesion. Use 43277 for qualifying duct or ampulla dilation when lesion ablation is not performed.
Is dilation separately reported with 43278?
Pre- or post-ablation dilation and guidewire passage are included when performed as part of the lesion-ablation service.
Can 43278 be reported with another endoscopy on the same date?
Related endoscopies performed together are subject to endoscopy family pricing. Document each service performed; CMS payment follows that pricing rule.
What documentation supports reporting 43278?
The ERCP report should identify the bile or pancreatic duct lesion treated and describe the ablation. Include any dilation performed and the duct involved.
Can an assistant surgeon or co-surgeon be paid for this procedure?
CMS does not pay an assistant at surgery for 43278. Co-surgeons and team surgery are not permitted.
Does this code have a postoperative global period?
It has a 0-day global period. Same-day preoperative and postoperative care is included.
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.
5,19943275,,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
5,20543281,,Lap paraesophag hern repair,A,,25.94,9.97,NA,9.97,,6.75,42.66,42.66,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00