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See a sample rate comparisonCPT 43262 Fee Schedule
Medicare rates as of October 2026
CPT 43262 is classified under Surgery, in the Surgical Procedures on the Digestive System subgroup.
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.
| 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 | 59 - Distinct Procedural Service 51 - Multiple procedures |
| Complexity Level | Moderate |
| Medicare Fee Schedule | $311.30 national non-facility rate (2026) · View Medicare rates for 43262 |
| Medicaid Fee Schedule | $263.77 median of the 8 states in the free preview · View Medicaid rates for 43262 |
National average reimbursement for CPT 43262 by major payers:
$510.82
BCBS / Anthem
$515.07
UnitedHealthcare
$549.93
Aetna
$608.31
Cigna
Compare published rates across providers.
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CPT 43262
5 of 25 sample ratesHigher to lower in this preview
Greater Dayton Surgery Center LLC
Greater Dayton Surgery Center
$7,441.00Published rateSummit Ambulatory Surgical Center LLC
$2,388.00Published rateOral Facial Surgery Center, LLC, Specialty Surgery Center
Oral Facial Surgery Center, Inc.
$1,474.00Published rateRegional Eye Surgery Center,LLC
Regional Eye Surgery Center, LLC
$956.00Published rateGastroenterology Endoscopy Center
$300.00Published rate
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See a sample payer proposalCPT 43262 vs. Other Surgical Procedures on the Digestive System Codes
The table lists codes related to 43262. Select one to see its fee schedule.
| 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 43262. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 43262 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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