No office rate
Use 43264 for endoscopic extraction of pancreatic duct stones during ERCP. CPT 48020 represents operative removal.
On this page
CMS RVU26D · Effective 2026-10-01
48020 Pancreatic stone removal Medicare reimbursement rates in Pennsylvania
Reports operative removal of a pancreatic calculus, rather than endoscopic duct clearance or lithotripsy performed during ERCP. Compare 48020 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 48020 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
$1078.02–$1170.48
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.
Pancreatic surgery
About 48020: Surgical pancreatic stone extraction
Reports operative removal of a pancreatic calculus, rather than endoscopic duct clearance or lithotripsy performed during ERCP.
CPT 48020 represents operative extraction of a stone from the pancreas or pancreatic duct. A surgeon performs the procedure in an operating-room setting when the stone is addressed surgically; it is distinct from clearing a duct endoscopically during ERCP. The operative report should identify the stone’s location and describe the removal performed.
Report the code when the operative service includes removal of the pancreatic stone, not simply drainage or treatment of a different pancreatic condition. The major-surgery global period includes the day-before preoperative visit and 90 days of related postoperative care. For multiple procedures in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard reduction. Modifier 50 is inappropriate for this descriptor. An assistant at surgery may be paid; co-surgeon payment requires supporting documentation, and team-surgery billing is not permitted.
CMS billing rules for 48020
- Global period
- Major surgery with a 90-day global period: the day-before preoperative visit and 90 days of related postoperative care are included.
- Multiple procedures
- Standard multiple procedure reduction: the highest-valued procedure is paid in full and others at 50% when performed in the same session.
- Bilateral procedures
- Bilateral adjustment does not apply; the descriptor or anatomy makes modifier 50 inappropriate.
- Assistant at surgery
- Assistant at surgery may be paid.
- Co-surgeons
- Co-surgeons paid only with supporting documentation.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU18.61 · 56%
- Practice expense (office) RVU9.78 · 29%
- Malpractice RVU4.96 · 15%
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.
48020 compared with similar codes
Office rates for Pennsylvania, from the same CMS release.
No office rate
Use 43265 when ERCP includes lithotripsy of duct stones. CPT 48020 describes surgical extraction rather than endoscopic fragmentation.
No office rate
CPT 48001 describes pancreatic drain placement, not stone extraction. Report 48020 only when the operative service includes removal of a pancreatic stone.
Compare 48020 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
$1170.48
Rest Of Pennsylvania →
Office / nonfacility
Unavailable
Facility
$1078.02
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48020 billing questions
How is this different from ERCP stone removal?
CPT 48020 is for operative removal. Use the ERCP stone-removal code when the calculus is cleared endoscopically from the pancreatic duct.
What documentation supports reporting 48020?
The operative report should establish a pancreatic stone and describe its location and surgical extraction. A note documenting only pancreatic drainage does not establish stone removal.
Can an assistant surgeon be reported?
Assistant-at-surgery payment may be available for this code. Co-surgeon payment requires supporting documentation.
What global and multiple-procedure rules apply?
The code has a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. In the same session, the highest-valued procedure is paid in full and other procedures receive the standard multiple-procedure reduction.
Should modifier 50 be used for stones on both sides?
No. Modifier 50 is inappropriate for this code’s descriptor and anatomy.
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.
5,72947999,,Unlisted px biliary tract,C,,0.00,0.00,,0.00,,0.00,0.00,0.00,0,YYY,0.00,0.00,0.00,2,0,1,1,1,9,,33.4009,09,0,99,0.00,0.00,0.00
5,73048000,,Drainage of abdomen,A,,31.15,12.82,NA,12.82,,8.33,52.30,52.30,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,73148001,,Placement of drain pancreas,A,,38.70,14.66,NA,14.66,,10.37,63.73,63.73,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,73248020,,Removal of pancreatic stone,A,,18.61,9.78,NA,9.78,,4.96,33.35,33.35,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,73348100,,Biopsy of pancreas open,A,,14.10,7.61,NA,7.61,,3.56,25.27,25.27,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,73448102,,Needle biopsy pancreas,A,,4.58,9.68,,1.03,,0.49,14.75,6.10,0,010,0.10,0.80,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,73548105,,Resect/debride pancreas,A,,48.03,18.08,NA,18.08,,10.41,76.52,76.52,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00