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See a sample rate comparisonCPT 43273 Fee Schedule
Last Verified: October 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 Cannulation Of Papi, Endoscopic Cannulation Of Papilla With Direct Visualization Of Common Bile Duct(S) Andor Pancreaticduct(S) (List Separately In Addition To Code(S) F Or Primary Procedure)
| 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 | 59 - Distinct Procedural Service 51 - Multiple procedures |
| Complexity Level | Low |
| Medicare Fee Schedule | $101.87 national non-facility rate (2026) · View Medicare rates for 43273 |
| Medicaid Fee Schedule | $83.045 median of the 8 states in the free preview · View Medicaid rates for 43273 |
National average reimbursement for CPT 43273 by major payers:
$170.89
$168.10
$175.53
$209.20
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CPT 43273
5 of 25 sample ratesHigher to lower in this preview
Saint Luke'S North Surgery Center, LLC
Saint Lukes North Surgery Center LLC
$6,623.00Published rateSurgical Specialty Center Of Mid Atlantic, LLC
Surgical Specialty Center Of Mid-Atlantic, LLC
$555.00Published rateScottsdale Eye Surgery Center, P.C
Scottsdale Eye Surgery Center
$329.00Published rateDallas Nephrology Associates, Dallas Nephrology Associates Vascular Center Dallas
Dallas Nephrology Associates, P.A.
$150.00Published rateCei Physicians Psc LLC, Cvp Surgery Center
Cincinnati Eye Institute
$67.00Published rate
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See a sample payer proposalCPT 43273 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 43273 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 43273 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. |
| 43273-CPT | Low | Endoscopic Cannulation Of Papi, Endoscopic Cannulation Of Papilla With Direct Visualization Of Common Bile Duct(S) Andor Pancreaticduct(S) (List Separately In Addition To Code(S) F Or Primary Procedure) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 43273. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 43273 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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