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See a sample rate comparisonCPT 43278 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 Lesion Ablate W Dilate, Endoscopic Retrograde Cholangiopancreatography Ercp With Ablation Of Tumor S Polyp S Or Other Lesion S Including Pre And Post Dilation And Guide Wire Passage When Performed
| 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 | 51 - Multiple procedures 59 - Distinct Procedural Service |
| Complexity Level | Moderate |
| Medicare Fee Schedule | $376.43 national non-facility rate (2026) · View Medicare rates for 43278 |
| Medicaid Fee Schedule | $306.215 median of the 8 states in the free preview · View Medicaid rates for 43278 |
National average reimbursement for CPT 43278 by major payers:
$573.20
$611.68
$618.36
$732.07
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CPT 43278
5 of 25 sample ratesHigher to lower in this preview
Memorial Care Surgical Center At Orange Coast, LLC
Memorial Care Surgical Center At Orange Coast LLC
$8,007.00Published rateUniversity Of Maryland Medicine Asc, LLC, University Of Maryland Surgery Center
University Of Maryland Medicine Asc LLC
$2,196.00Published rateGreat South Bay Endoscopy Center, LLC
Great South Bay Endoscopy Center LLC
$1,475.00Published rateDha Endoscopy LLC
$1,041.00Published rateTucson Gastroenterology Institute, LLC
Tucson Gastroenterology Institute LLC
$575.00Published rate
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See a sample payer proposalCPT 43278 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 43278 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 43278 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 |
|---|---|---|
| 43265-CPT | Moderate | Endoscopic Retrograde Cholangi, Endoscopic Retrograde Cholangiopancreatography (Ercp) With Destruction Of Calculi Any Method (Eg Mechanical Electrohydraulic Lithotripsy) |
| 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 |
| 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 |
| 43278-CPT | Moderate | Ercp Lesion Ablate W Dilate, Endoscopic Retrograde Cholangiopancreatography Ercp With Ablation Of Tumor S Polyp S Or Other Lesion S Including 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 43278. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 43278 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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