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See a sample rate comparisonCPT 43277 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 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
| 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 XS - Separate Structure |
| Complexity Level | Moderate |
| Medicare Fee Schedule | $330.00 national non-facility rate (2026) · View Medicare rates for 43277 |
| Medicaid Fee Schedule | $268.58 median of the 8 states in the free preview · View Medicaid rates for 43277 |
National average reimbursement for CPT 43277 by major payers:
$520.74
$535.64
$552.99
$642.67
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CPT 43277
5 of 25 sample ratesHigher to lower in this preview
Central Louisiana Ambulatory Surgical Center LLC
Central Louisiana Surgical Hospital, LLC
$3,991.00Published rateAz West Endoscopy Center LLC
$2,388.00Published rateGenesee Care L.L.C., The Surgery Center Of Genesee County
Genesee Care LLC
$2,000.00Published rateOutpatient Surgical Services Ltd
$1,518.00Published rateMidsouth Interventional Pain Institute, LLC
Midsouth Interventional Pain Institute LLC
$677.00Published rate
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See a sample payer proposalCPT 43277 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 43277 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 43277 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 |
|---|---|---|
| 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) |
| 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. |
| 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 43277. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 43277 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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