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See a sample rate comparisonCPT 43260 Fee Schedule
Last Verified: September 2026
Healthcare providers use this code to document and receive reimbursement for visits that address moderate-level medical decision-making, often including multiple diagnoses or prescription management.
Endoscopic Retrograde Cholangiopancreatography (Ercp); Diagnostic Including Collection Of Specimen(S) By Brushing Or Washing When Performed(Separate Procedure) (Revised 01/01/2014)
| Key Fact | Detail |
|---|---|
| Service Type | Surgery Surgical Procedures on the Digestive System |
| Common Place of Service | 21 - Inpatient Hospital 22 - On Campus Outpatient Hospital |
| Common Modifiers | None 53 - Discontinued procedure 52 - Reduced Services |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 43260 |
| Medicaid Fee Schedule | View Medicaid rates for 43260 |
National average reimbursement for CPT 43260 by major payers:
$425.63
$447.73
$475.63
$535.63
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CPT 43260
5 of 25 sample ratesHigher to lower in this preview
South Emerson Surgery Center, LLC
$7,688.00Published ratePrince Frederick Surgery Center LLC
Prince Frederick Surgery Center, LLC
$2,307.00Published rateSalmon Creek Plastic Surgery PC, Salmon Creek Plastic Surgery PC/Asc Facility
Salmon Creek Plastic Surgery, PC
$1,436.00Published rateMethodist Ambulatory Surgery Center Of Landmark, LLC
Methodist Ambulatory Surgery Center Of Landmark LLC
$830.00Published rateBrooklyn Endoscopy Sc, LLC, Gnyesc
Brooklyn Endoscopy Sc LLC
$432.00Published rate
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See a sample payer proposalCPT 43260 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 43260 code is part of the Surgery services used for Surgical Procedures on the Digestive System. It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.
The CPT 43260 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.
| Code | Complexity | Description |
|---|---|---|
| 43260-CPT | Moderate | Endoscopic Retrograde Cholangiopancreatography (Ercp); Diagnostic Including Collection Of Specimen(S) By Brushing Or Washing When Performed(Separate Procedure) (Revised 01/01/2014) |
| 43263-CPT | Moderate | Scope Exam Of Bile Ducts, Examination Of The Bile Ducts And Pancreatic Ducts Using A Scope. The Procedure Includes Pressure Measurement Of A Sphincter (Band Of Muscle Around An Opening). |
| 43264-CPT | Moderate | Endoscopic Retrograde Cholangi, Endoscopic Retrograde Cholangiopancreatography (Ercp) With Endoscopic Retrograde Removal Of Stone(S) From Biliary Andor Pancreatic Ducts |
| 43265-CPT | Moderate | Endoscopic Retrograde Cholangi, Endoscopic Retrograde Cholangiopancreatography (Ercp) With Destruction Of Calculi Any Method (Eg Mechanical Electrohydraulic Lithotripsy) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 43260. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 43260 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.
Factors that affect fee schedules
Medicare & Medicaid Rates
Government-set reimbursement amounts
Private Insurance Rates
Negotiated rates between providers and insurance companies
Geographic Location
Costs may be higher in urban areas.
Provider Type
Hospital providers may have different rates than private practice.
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