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See a sample rate comparisonCPT 43275 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.
Scope Exam Of Bile Ducts, Examination Of The Bile Ducts And Pancreatic Ducts Using A Scope. The Procedure Removes A Foreign Object From The Area Or Changes Out A Support Device That Is In Place.
| 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 | Moderate |
| Medicare Fee Schedule | $328.33 national non-facility rate (2026) · View Medicare rates for 43275 |
| Medicaid Fee Schedule | $267.02 median of the 8 states in the free preview · View Medicaid rates for 43275 |
National average reimbursement for CPT 43275 by major payers:
$510.90
$532.64
$545.87
$638.91
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CPT 43275
5 of 25 sample ratesHigher to lower in this preview
Texas Health Harris Methodist Hospital Azle
$3,607.00Published rateBaylor Scott & White Surgicare Waxahachie LLC
$1,955.00Published rateVascular Labs Of The Rockies Asc, LLC
Vascular Labs Of The Rockies Asc LLC
$840.00Published rateCommonwealth Eye Clinic Inc
$519.00Published rateLorie Hessler
Deaconess Hospital Inc
$313.26Published rate
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See a sample payer proposalCPT 43275 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 43275 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 43275 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 |
| 43274-CPT | Moderate | Ercp Duct Stent Placement, Endoscopic Retrograde Cholangiopancreatography Ercp With Placement Of Endoscopic Stent Into Biliary Or Pancreatic Duct Including Pre And Post Dilation And Guide Wire Passage When Performed Including Sphincterotomy When Performed Each Stent |
| 43275-CPT | Moderate | Scope Exam Of Bile Ducts, Examination Of The Bile Ducts And Pancreatic Ducts Using A Scope. The Procedure Removes A Foreign Object From The Area Or Changes Out A Support Device That Is In Place. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 43275. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 43275 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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