Billing code 43274: ERCP stentingMedicare rate & RVUs in Washington
Reports endoscopic placement of a stent in a bile or pancreatic duct during ERCP, including related guidewire passage and specified accompanying maneuvers.
CMS doesn’t publish an office rate for 43274 in Washington.
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 43274 covers
During ERCP, a gastroenterologist advances a side-viewing endoscope through the mouth to the duodenum, accesses the biliary or pancreatic duct, and places a stent to maintain drainage or passage. Typical situations include duct narrowing, obstruction, or a leak requiring endoscopic drainage. The service is most often performed in a hospital or ambulatory endoscopy facility.
Report 43274 when the procedure includes ductal stent placement. The operative report should identify the duct treated, the reason for stenting, and the placement performed. Guidewire passage, pre- or post-dilation, and sphincterotomy are included when performed as part of this service. The code has a 0-day global period, so same-day preoperative and postoperative care is included. When related endoscopies are performed together, endoscopy family pricing applies. Modifier 50 is inappropriate for this code; Medicare also does not pay an assistant at surgery, co-surgeons, or a surgical team for it.
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 43274 pays more and less in Washington
| Payment locality | Office | Facility |
|---|---|---|
| Rest Of Washington | Unavailable | $403.44 |
| Seattle (King Cnty) | Unavailable | $431.94 |
How the 43274 rate is calculated
Each of 43274’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 · 43274
RVUs × geographic indexes × conversion factor
Work8.27
8.27 RVUs× 1.000 GPCI
Practice expense2.85
2.85 RVUs× 1.000 GPCI
Malpractice0.92
0.92 RVUs× 1.000 GPCI
Adjusted RVUs
12.0400
Conversion factor
$33.4009
Medicare rate
$402.15
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 43274
The CMS indicators that decide how 43274 is paid alongside other services.
CMS payment indicators · 43274
ERCP stenting
| 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
43274 without 51 · national facility
$402.15
ERCP stenting
43274-51 · Second procedure: 50%
$201.08
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%).
43274 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 43276ERCP stent exchange
- Choose 43274 for ductal stent placement. Choose 43276 when an existing ductal stent is removed and exchanged.
- 43266Endoscopic stent
- 43266 describes endoscopic stent placement in the upper GI tract. 43274 is for placement in a biliary or pancreatic duct during ERCP.
- 43264ERCP extraction
- 43264 reports ERCP removal of ductal calculi; 43274 reports ductal stent placement. The operative report should support the intervention performed.
43274 billing questions
How does 43274 differ from 43276?
43274 reports placement of a stent in a biliary or pancreatic duct. 43276 applies when a ductal stent is removed and exchanged.
Is sphincterotomy separately reported with 43274?
Sphincterotomy is included when performed as part of the stent-placement service. The same applies to guidewire passage and pre- or post-dilation.
Can modifier 50 be used for stents in both ducts?
No. Medicare's bilateral adjustment does not apply to 43274, and modifier 50 is inappropriate for this code.
What documentation supports reporting 43274?
Document the indication for ductal drainage, the biliary or pancreatic duct treated, and the stent placement. Record related maneuvers performed during the ERCP.
What happens when another related endoscopy is performed in the same session?
CMS endoscopy family pricing applies when related endoscopies are performed together. Same-day preoperative and postoperative care is included under the 0-day global period.
Can an assistant or co-surgeon be billed for this procedure?
Medicare does not pay an assistant at surgery for 43274. 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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