No office rate
43260 covers duct specimen collection by brushing or washing. Choose 43261 for tissue sampling by biopsy.
On this page
CMS RVU26D · Effective 2026-10-01
43260 ERCP Medicare reimbursement rates in Rhode Island
Diagnostic ERCP with ductal brushing or washing is reported when the endoscopist collects specimens from the biliary or pancreatic ducts. Compare 43260 office and facility rates across CMS payment localities in Rhode Island.
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 43260 in Rhode Island?
Rhode Island has 1 payment locality in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the payment area shown below, using the same CMS release.
Office / nonfacility
No supported rate
Facility setting
$284.59
1 of 1 localities have a supported rate.
Payment area: Rhode Island
One mapped payment locality.
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
About 43260: ERCP with duct specimen collection
Diagnostic ERCP with ductal brushing or washing is reported when the endoscopist collects specimens from the biliary or pancreatic ducts.
A gastroenterologist advances an endoscope through the mouth to the duodenum, accesses the biliary or pancreatic ducts, and uses contrast imaging to evaluate ductal anatomy. This service includes collecting duct specimens by brushing or washing when performed. It may be used to investigate a suspected ductal stricture, obstruction, or other abnormality, often in a hospital or ambulatory endoscopy facility.
Report 43260 when the documented ERCP includes brushing or washing for specimen collection; forceps tissue sampling is distinguished by 43261. Documentation should identify the duct examined, the collection method, and the findings. The 0-day global period includes same-day preoperative and postoperative care. For multiple procedures in one session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% reduction. Modifier 50 is inappropriate for this service. Medicare does not pay an assistant at surgery; co-surgeons and team surgery are not permitted.
CMS billing rules for 43260
- Global period
- Minor procedure with a 0-day global period: same-day preoperative and postoperative care is 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
- 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 RVU5.70 · 68%
- Practice expense (office) RVU2.09 · 25%
- Malpractice RVU0.62 · 7%
3.2K
Medicare services in 2024 · #2132 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.
43260 compared with similar codes
Office rates for Rhode Island, from the same CMS release.
No office rate
43262 describes ERCP with sphincterotomy or papillotomy, a duct-opening intervention rather than specimen collection.
No office rate
43264 is for ERCP with duct calculus removal; 43260 describes diagnostic duct evaluation with brushing or washing.
No office rate
43274 describes ERCP with duct stent placement. A stent procedure is distinct from the specimen-collection service in 43260.
Compare 43260 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.
1 of 1 payment localities
Rhode Island →
Office / nonfacility
Unavailable
Facility
$284.59
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How this local rate is calculated
Each RVU component is multiplied by its own geographic practice cost index (GPCI). The three adjusted components are added, then multiplied by the conversion factor. These are the inputs used for 43260 in Rhode Island.
PPRRVU2026_Oct_nonQPP.csv
5,188
- Code
- 43260
- Physician work
- 5.70
- Practice expense
- 2.09
- Malpractice
- 0.62
GPCI2026.csv
92
- Locality
- Rhode Island
- Physician work
- 1.019
- Practice expense
- 1.033
- Malpractice
- 0.892
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 5.70 | × 1.019 | 5.8083 |
| Practice expense | 2.09 | × 1.033 | 2.1590 |
| Malpractice | 0.62 | × 0.892 | 0.5530 |
| Total RVUs | 8.5203 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Rhode Island$284.59
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 5.7 | 1.019 |
| Practice expense | 2.09 | 1.033 |
| Malpractice | 0.62 | 0.892 |
(5.7 × 1.019 + 2.09 × 1.033 + 0.62 × 0.892) × $33.4009 = $284.59
The office and facility calculations use their respective practice-expense RVUs. The facility amount here is the physician fee, not a separate hospital or facility bill.
43260 billing questions
When should 43260 be chosen instead of 43261?
Use 43260 for ERCP with ductal specimen collection by brushing or washing. Use 43261 when the endoscopist takes tissue by biopsy.
Is brushing or washing separately reported?
The ductal brushing or washing specimen collection is included in 43260. The operative report should state the collection method and site.
Can 43260 be reported with an ERCP treatment code?
Code the ERCP services actually performed and documented, including therapeutic work when supported. When multiple procedures occur in the same session, CMS applies the multiple-procedure reduction to the lower-valued procedures.
Should modifier 50 be appended?
No. Modifier 50 is inappropriate for this ERCP service.
Can an assistant or co-surgeon be paid for 43260?
Medicare does not pay an assistant at surgery for this service, and co-surgeons and team surgery are not permitted.
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.
5,18543257,,Egd w/thrml txmnt gerd,A,,4.05,1.62,NA,1.62,,0.45,6.12,6.12,0,000,0.00,0.00,0.00,3,0,1,0,0,9,43235,33.4009,09,0,99,0.00,0.00,0.00
5,18643259,,Egd us exam duodenum/jejunum,A,,3.94,1.58,NA,1.58,,0.43,5.95,5.95,0,000,0.00,0.00,0.00,3,0,1,0,0,9,43235,33.4009,09,0,99,0.00,0.00,0.00
5,1874325F,,Med txmnt options rvwd w/pt,M,,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
5,18843260,,Ercp w/specimen collection,A,,5.70,2.09,NA,2.09,,0.62,8.41,8.41,0,000,0.00,0.00,0.00,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,18943261,,Endo cholangiopancreatograph,A,,6.00,2.18,NA,2.18,,0.67,8.85,8.85,0,000,0.00,0.00,0.00,3,0,1,0,0,9,43260,33.4009,09,0,99,0.00,0.00,0.00
5,19043262,,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
8912502,PA,01,METROPOLITAN PHILADELPHIA,1.018,1.041,1.193
9012502,PA,99,REST OF PENNSYLVANIA,1.000,0.918,0.945
9109202,PR,20,PUERTO RICO,1.000,1.011,0.985
9214412,RI,01,RHODE ISLAND,1.019,1.033,0.892
9311202,SC,01,SOUTH CAROLINA,1.000,0.924,0.850
9403402,SD,02,SOUTH DAKOTA**,1.000,1.000,0.336
9510312,TN,35,TENNESSEE,1.000,0.909,0.537