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See a sample rate comparisonCPT 43276 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.
Ercp Stent Exchange W Dilate, Endoscopic Retrograde Cholangiopancreatography Ercp With Removal And Exchange Of Stent S Biliary Or Pancreatic Duct Including Pre And Post Dilation And Guide Wire Passage When Performed Including Sphincterotomy When Performed Each Stent Exchanged
| 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 XS - Separate Structure |
| Complexity Level | Moderate |
| Medicare Fee Schedule | $419.18 national non-facility rate (2026) · View Medicare rates for 43276 |
| Medicaid Fee Schedule | $340.87 median of the 8 states in the free preview · View Medicaid rates for 43276 |
National average reimbursement for CPT 43276 by major payers:
$622.69
$678.00
$700.41
$811.49
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CPT 43276
5 of 25 sample ratesHigher to lower in this preview
Wasatch Front Surgery Center LLC
$3,099.00Published rateWest Coast Centers For Surgeries LLC
$2,300.00Published rateOcala Eye Surgery Center Inc
$1,295.00Published rateAdvanced Eye Surgery Center
$1,030.13Published rateCourtney Merkel
Deaconess Hospital Inc
$400.91Published rate
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See a sample payer proposalCPT 43276 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 43276 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 43276 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 |
|---|---|---|
| 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. |
| 43276-CPT | Moderate | Ercp Stent Exchange W Dilate, Endoscopic Retrograde Cholangiopancreatography Ercp With Removal And Exchange Of Stent S Biliary Or Pancreatic Duct Including Pre And Post Dilation And Guide Wire Passage When Performed Including Sphincterotomy When Performed Each Stent Exchanged |
| 43277-CPT | Moderate | Ercp Ea Duct Ampulla Dilate, Endoscopic Retrograde Cholangiopancreatography Ercp With Trans Endoscopic Balloon Dilation Of Biliary Pancreatic Duct S Or Of Ampulla Sphincteroplasty Including Sphincterotomy When Performed Each Duct |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 43276. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 43276 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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