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See a sample rate comparisonCPT 43265 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 Cholangi, Endoscopic Retrograde Cholangiopancreatography (Ercp) With Destruction Of Calculi Any Method (Eg Mechanical Electrohydraulic Lithotripsy)
| Key Fact | Detail |
|---|---|
| Service Type | Surgery Surgical Procedures on the Digestive System |
| Common Place of Service | 22 - On Campus Outpatient Hospital 21 - Inpatient Hospital |
| Common Modifiers | None 51 - Multiple procedures 59 - Distinct Procedural Service |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 43265 |
| Medicaid Fee Schedule | View Medicaid rates for 43265 |
National average reimbursement for CPT 43265 by major payers:
$621.73
$646.90
$678.48
$750.75
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CPT 43265
5 of 25 sample ratesHigher to lower in this preview
Grass Valley Surgery Center, LLC
$4,304.00Published rateAesthetic Associates Inc., P.S., Seattle Facial Plastic Surgery Center
Aesthetic Associates Inc Ps
$2,000.00Published rateOlol Pontchartrain Surgery Center, LLC, Our Lady Of The Lake Pontchartrain Surgery Center
Olol Pontchartrain Surgery Cente
$1,530.00Published rateSan Marcos Asc LLC
$830.00Published rateKristi Cottrell
Deaconess Hospital Inc
$360.38Published rate
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See a sample payer proposalCPT 43265 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 43265 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 43265 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) |
| 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) |
| 43266-CPT | Moderate | Esophagogastroduodenoscopy Fl, Esophagogastroduodenoscopy Flexible Transoral With Placement Of Endoscopic Stent (Includes Pre- And Post-Dilation And Guide Wire Passage When Performed) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 43265. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 43265 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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