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See a sample rate comparisonCPT 43261 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.
Scope Exam Of Bile Ducts, Examination Of The Bile Ducts And Pancreatic Ducts Using A Scope. The Procedure Removes A Sample Of Tissue For Testing.
| 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 59 - Distinct Procedural Service XS - Separate Structure |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 43261 |
| Medicaid Fee Schedule | View Medicaid rates for 43261 |
National average reimbursement for CPT 43261 by major payers:
$461.80
$469.65
$497.11
$561.53
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CPT 43261
5 of 25 sample ratesHigher to lower in this preview
St. Joseph'S Surgery Center Lp
St Josephs Surgery Center Lp
$4,599.00Published rateSummit Ambulatory Surgical Center, LLC
$2,307.00Published rateSouth Jersey Endoscopy LLC, Dimarino-Kroop-Prieto Gi Assoc
South Jersey Endoscopy LLC
$1,509.00Published rateUsama Bukhari
Deaconess Hospital Inc
$612.94Published rateAmy Sullivan
Deaconess Hospital Inc
$281.61Published rate
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See a sample payer proposalCPT 43261 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 43261 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 43261 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) |
| 43261-CPT | Moderate | Scope Exam Of Bile Ducts, Examination Of The Bile Ducts And Pancreatic Ducts Using A Scope. The Procedure Removes A Sample Of Tissue For Testing. |
| 43262-CPT | Moderate | Scope Exam Of Bile Ducts, Examination Of The Bile Ducts And Pancreatic Ducts Using A Scope. The Procedure Includes Cutting Of A Sphincter (Band Of Muscle Around An Opening) To Free The Flow Of Bile Blocked By A Gallstone Or Other Material. |
| 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). |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 43261. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 43261 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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