No office rate
43261 reports ERCP biopsy. 43273 reports direct visualization inside the pancreatic duct; do not substitute one for the other based solely on duct inspection.
On this page
CMS RVU26D · Effective 2026-10-01
43273 Pancreatoscopy Medicare reimbursement rates in Pennsylvania
Report this add-on when ERCP includes direct endoscopic visualization inside the pancreatic duct, such as evaluation of a duct stricture, stone, or intraductal lesion. Compare 43273 office and facility rates across CMS payment localities in Pennsylvania.
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 43273 in Pennsylvania?
Pennsylvania 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
$99.70–$105.54
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.
Endoscopy
About 43273: Direct pancreatic duct visualization during ERCP
Report this add-on when ERCP includes direct endoscopic visualization inside the pancreatic duct, such as evaluation of a duct stricture, stone, or intraductal lesion.
During ERCP, the endoscopist advances a small-caliber imaging scope through the duodenoscope and into the pancreatic duct to inspect the duct lining directly. Gastroenterologists typically perform this in an endoscopy suite, often when duct imaging raises a question about a stricture, pancreatic duct stone, or intraductal lesion. The service represents direct intraductal visualization, not simply the fluoroscopic images obtained during routine ERCP.
Report 43273 only with an appropriate primary ERCP procedure; it is not a standalone service. The record should identify the pancreatic duct as the site examined and document that direct visualization was performed, along with the clinical finding or question that prompted it. CMS classifies 43273 as an add-on code, with payment occurring within the primary procedure's global period. A report of duct cannulation or fluoroscopic imaging alone does not support this distinct visualization service.
CMS billing rules for 43273
- Global period
- Add-on code: billed only together with a primary procedure and paid within that procedure's global period.
Where the value comes from
- Work RVU2.18 · 71%
- Practice expense (office) RVU0.64 · 21%
- Malpractice RVU0.23 · 8%
9K
Medicare services in 2024 · #1532 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.
43273 compared with similar codes
Office rates for Pennsylvania, from the same CMS release.
No office rate
43263 involves sphincter pressure measurement during ERCP. 43273 is direct visual examination within the pancreatic duct.
No office rate
43264 reports ERCP removal of duct stones or debris. 43273 reports direct pancreatic duct visualization, not extraction.
Compare 43273 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
Metropolitan Philadelphia →
Office / nonfacility
Unavailable
Facility
$105.54
Rest Of Pennsylvania →
Office / nonfacility
Unavailable
Facility
$99.70
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43273 billing questions
Can 43273 be reported by itself?
No. It is an add-on code and must be reported with an appropriate primary ERCP procedure.
What distinguishes pancreatoscopy from routine ERCP imaging?
43273 represents direct endoscopic inspection inside the pancreatic duct. Fluoroscopic duct imaging during ERCP alone is not pancreatoscopy.
Is pancreatic duct stone extraction included in 43273?
The code describes direct visualization, not stone removal. When a separately reportable ERCP treatment is performed, report the applicable primary procedure as well.
What documentation supports 43273?
Document direct visualization within the pancreatic duct, the reason for examining it, and the findings. A note describing only duct cannulation or fluoroscopy is insufficient.
How does 43273 differ from ERCP biopsy?
43273 is for direct pancreatic duct visualization; 43261 describes ERCP biopsy. Use the code that reflects the service actually performed, and document each service reported.
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.
5,19443266,,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
5,19743273,,Endoscopic pancreatoscopy,A,,2.18,0.64,NA,0.64,,0.23,3.05,3.05,0,ZZZ,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
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