CPT code 43263: ERCP manometry2026 Medicare rate & RVUs in Virginia
Report this service when an endoscopist performs sphincter of Oddi pressure measurements during ERCP to evaluate suspected biliary or pancreatic outflow dysfunction.
CMS doesn’t publish an office rate for 43263 in Virginia.
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 43263 covers
During ERCP, the endoscopist uses a manometry catheter to measure pressure at the sphincter of Oddi, which regulates bile and pancreatic juice flow into the duodenum. Gastroenterologists typically perform the study in a hospital or ambulatory endoscopy setting, often when evaluating suspected sphincter-related outflow problems. The service involves actual pressure measurement; ERCP imaging or cannulation alone does not support reporting it.
Select this code when the procedure record documents sphincter pressure measurements, the anatomy assessed, and relevant findings. The ERCP access and pressure study are represented together, so do not separately report a diagnostic ERCP code for the same service. CMS assigns a 0-day global period, including same-day preoperative and postoperative care. When related endoscopies are performed together, CMS applies endoscopy-family pricing. Modifier 50 is inappropriate for this code. Medicare does not pay an assistant at surgery, and co-surgeons and team surgery are not permitted.
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.
Where 43263 pays more and less in Virginia
| Payment locality | Office | Facility |
|---|---|---|
| Dc + Md/Va Suburbs | Unavailable | $339.72 |
| Virginia | Unavailable | $303.78 |
How the 43263 rate is calculated
Each of 43263’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 · 43263
RVUs × geographic indexes × conversion factor
Work6.34
6.34 RVUs× 1.000 GPCI
Practice expense2.30
2.30 RVUs× 1.000 GPCI
Malpractice0.70
0.70 RVUs× 1.000 GPCI
Adjusted RVUs
9.3400
Conversion factor
$33.4009
Medicare rate
$311.96
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 43263
The CMS indicators that decide how 43263 is paid alongside other services.
CMS payment indicators · 43263
ERCP manometry
| 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
43263 without 51 · national facility
$311.96
ERCP manometry
43263-51 · Second procedure: 50%
$155.98
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%).
43263 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 43260ERCP
- This code requires sphincter pressure measurement. Use 43260 for diagnostic ERCP without manometry.
- 43262ERCP sphincterotomy
- This code reports sphincter pressure measurement; 43262 reports therapeutic papillary sphincterotomy.
- 43264ERCP extraction
- This code covers pressure measurement, while 43264 covers endoscopic removal of duct calculi.
43263 billing questions
When should this code be chosen instead of a diagnostic ERCP code?
Choose it when sphincter of Oddi pressure is actually measured during ERCP. A diagnostic ERCP without manometry does not support this code.
Can the diagnostic ERCP be reported separately for the same procedure?
The pressure-measurement service includes ERCP, so do not separately report a diagnostic ERCP code for the same access and study.
What documentation supports reporting this service?
The procedure report should identify the sphincter pressure measurements performed, the anatomy assessed, and the findings. ERCP imaging or cannulation alone is not enough.
How does CMS price it with another endoscopy?
When related endoscopies are performed together, CMS applies endoscopy-family pricing. The same-day preoperative and postoperative care is included under the 0-day global period.
Can modifier 50 or an assistant-at-surgery claim be used?
Modifier 50 is inappropriate for this code. Medicare does not pay an assistant at surgery for the service.
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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