CPT code 43273: Pancreatoscopy2026 Medicare rate & RVUs in Utah
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.
CMS doesn’t publish an office rate for 43273 in Utah.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
On this page 9 sections
What 43273 covers
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.
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 in Utah
| Payment locality | Office | Facility |
|---|---|---|
| Utah | Unavailable | $99.81 |
How the 43273 rate is calculated
Each of 43273’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.
How the rate is built · 43273
RVUs × geographic indexes × conversion factor
Work2.18
2.18 RVUs× 1.000 GPCI
Practice expense0.64
0.64 RVUs× 1.000 GPCI
Malpractice0.23
0.23 RVUs× 1.000 GPCI
Adjusted RVUs
3.0500
Conversion factor
$33.4009
Medicare rate
$101.87
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 43273
The CMS indicators that decide how 43273 is paid alongside other services.
CMS payment indicators · 43273
Pancreatoscopy
| Rule | CMS value | What it means |
|---|---|---|
| Global period | ZZZ | Add-on code: falls within the primary procedure’s global period. |
| Multiple procedures | 0 | No multiple-procedure reduction. |
| Bilateral (modifier 50) | 0 | The 150% bilateral adjustment doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 0 | Not paid without supporting documentation. |
| Co-surgeons (62) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
43273 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 43261ERCP
- 43261 reports ERCP biopsy. 43273 reports direct visualization inside the pancreatic duct; do not substitute one for the other based solely on duct inspection.
- 43263ERCP manometry
- 43263 involves sphincter pressure measurement during ERCP. 43273 is direct visual examination within the pancreatic duct.
- 43264ERCP extraction
- 43264 reports ERCP removal of duct stones or debris. 43273 reports direct pancreatic duct visualization, not extraction.
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 indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.
CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027
Show the CMS file lines behind this rate
Fee sheets
Put 43273 and the rest of your codes on one sheet
Build a fee sheet from your own code list at your locality, put your payer contracts beside Medicare, and see what changed each quarter.
Build my fee sheetOr price your code list free →