Billing code 43277: ERCP dilationMedicare rate & RVUs in Utah
ERCP balloon dilation enlarges a narrowed biliary or pancreatic duct, or the ampulla, and is reported for each treated duct during therapeutic endoscopy.
CMS doesn’t publish an office rate for 43277 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 43277 covers
During ERCP, the endoscopist guides a balloon to a narrowed biliary or pancreatic duct, or the ampulla, and expands it to improve passage through the narrowed area. Gastroenterologists and other endoscopists with therapeutic ERCP expertise typically perform this in a hospital or ambulatory endoscopy facility. Common indications include a duct stricture or papillary narrowing. Sphincterotomy, when performed as part of the dilation service, is included.
Report the service for each duct treated; documentation should identify the duct or ampulla and the dilation performed. This is a minor procedure with a 0-day global period, so same-day preoperative and postoperative care is included. When related endoscopies are performed together, Medicare applies endoscopy family pricing rather than treating each service as unrelated. Modifier 50 is inappropriate for this anatomy and service. Medicare does not pay an assistant at surgery, and co-surgeons and team surgery are not permitted for this code.
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.
43277 in Utah
| Payment locality | Office | Facility |
|---|---|---|
| Utah | Unavailable | $322.64 |
How the 43277 rate is calculated
Each of 43277’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 · 43277
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 6.73Practice expense 2.40Malpractice 0.75
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 43277
The CMS indicators that decide how 43277 is paid alongside other services.
CMS payment indicators · 43277
ERCP dilation
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 000 | Same-day global: pre- and post-op care on the day of the procedure is included. |
| Multiple procedures | 3 | Endoscopy family rules apply. |
| Bilateral (modifier 50) | 0 | The 150% bilateral adjustment doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 1 | Not paid (statutory restriction). |
| Co-surgeons (62) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
What modifiers do to the payment
Modifier 51 · payment effect
With and without the modifier
43277 without 51 · national facility
$330.00
ERCP dilation
43277-51 · Second procedure: 50%
$165.00
When this isn’t the highest-valued procedure in the session, Medicare pays 50% of its fee schedule amount (the highest is paid at 100%).
43277 compared with similar codes
Compare codes
43277 vs 43264 vs 43276 vs 43278 vs 43274: national Medicare rates
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How to choose
- 43264ERCP extraction
- 43277 describes balloon dilation of a duct or ampulla; 43264 describes duct-stone extraction. The procedures may occur during the same ERCP when both are performed.
- 43276ERCP stent exchange
- 43276 applies when a duct stent is removed and exchanged, with dilation included when performed. Use 43277 for duct or ampulla dilation when stent exchange is not the service being described.
- 43278ERCP ablation
- 43278 describes lesion ablation with dilation. 43277 describes dilation without that ablation service.
- 43274ERCP stenting
- 43274 describes placement of a duct stent. 43277 describes balloon dilation; choose based on the documented intervention, not simply the presence of a duct narrowing.
43277 billing questions
How is 43277 distinguished from stone-removal ERCP?
Use 43277 for balloon dilation of a duct or the ampulla. When the documented intervention is duct-stone extraction, compare it with 43264; dilation alone does not describe extraction.
Can 43277 be reported for more than one duct?
The code is reported for each duct treated. Document the specific duct or ducts dilated and the work performed at each site.
Is sphincterotomy separately reported with 43277?
Sphincterotomy performed as part of the dilation is included. Do not separately report it as though it were an unrelated service.
Should modifier 50 be used for dilation on both sides?
No. CMS identifies bilateral adjustment as inappropriate for this code; the duct-based descriptor and anatomy do not call for modifier 50.
What same-day care is included in the global period?
The 0-day global period includes same-day preoperative and postoperative care. It does not extend the global period beyond the procedure date.
Can an assistant surgeon or co-surgeon be paid for 43277?
Medicare does not pay an assistant at surgery for this code. 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 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
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