No office rate
43274 is for placing a duct stent without exchanging an existing one. Choose 43276 when the procedure removes and replaces a stent.
On this page
CMS RVU26D · Effective 2026-10-01
43276 ERCP stent exchange Medicare reimbursement rates in Pennsylvania
Reports ERCP removal and exchange of a biliary or pancreatic duct stent, including dilation performed to facilitate the exchange. Compare 43276 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 43276 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
$409.30–$434.72
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 endoscopy
About 43276: ERCP biliary or pancreatic stent exchange with dilation
Reports ERCP removal and exchange of a biliary or pancreatic duct stent, including dilation performed to facilitate the exchange.
During ERCP, a gastroenterologist advances an endoscope through the mouth into the duodenum to reach a biliary or pancreatic duct. This service covers removing an existing duct stent and exchanging it for a replacement; dilation may be performed as part of that work. Exchanges may be needed when a stent is obstructed or has migrated, or as part of ongoing management of a duct stricture. ERCP is generally performed in a hospital or ambulatory endoscopy setting.
Report the service for each stent exchanged, and document the duct, stent removal and replacement, and any dilation performed. Dilation included in the exchange is not a separate service for that same work. When related endoscopies are performed together, CMS endoscopy-family pricing applies. The procedure has a 0-day global period, so same-day preoperative and postoperative care is included. Modifier 50 is inappropriate for this anatomy and descriptor. Medicare does not pay an assistant at surgery for this service; co-surgeons and team surgery are not permitted.
CMS billing rules for 43276
- 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 RVU8.62 · 69%
- Practice expense (office) RVU2.95 · 24%
- Malpractice RVU0.98 · 8%
17.1K
Medicare services in 2024 · #1206 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.
43276 compared with similar codes
Office rates for Pennsylvania, from the same CMS release.
No office rate
43275 describes removal without exchange. If a replacement stent is inserted, the exchange service is represented by 43276.
No office rate
43277 describes duct or ampullary dilation. Dilation performed as part of the stent exchange is included in 43276, rather than separately reported for that same work.
Compare 43276 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
$434.72
Rest Of Pennsylvania →
Office / nonfacility
Unavailable
Facility
$409.30
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43276 billing questions
When should 43276 be selected instead of 43274?
Use 43276 when an existing biliary or pancreatic duct stent is removed and exchanged. Code 43274 describes placement of a stent without the exchange service.
How is the number of units determined?
Report one unit for each stent exchanged. The record should identify the stents removed and replaced.
Can dilation be reported separately?
Dilation performed as part of the stent exchange is included. Document the duct and the work performed; do not separately report that same dilation as 43277.
Can 43275 be used when the stent is removed?
43275 describes removal without exchange. When the existing stent is removed and replaced, 43276 represents the exchange service.
Does modifier 50 apply, or can an assistant be paid?
Modifier 50 is inappropriate for this code. Medicare does not pay an assistant at surgery for 43276.
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.
5,19743273,,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
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