# CPT 43260: ERCP, diagnostic

Medicare CPT 43260 pays $280.90 in a non-facility setting and $280.90 in a facility setting under the 2026 Medicare Physician Fee Schedule, before geographic adjustment. After geographic adjustment, state amounts run from $261.02 in Arkansas to $371.33 in Alaska, a 42% spread.

Web page: https://www.med-reveal.com/rates/43260-cpt-fee-schedule
Section: Surgery and Procedures
Billed by: Gastroenterology

## Medicare rates

| | Amount |
| --- | --- |
| National non-facility | $280.90 |
| National facility | $280.90 |
| Conversion factor | 33.4009 |
| Release | 2026 Q4 (effective 2026-10-01) |

## By state

| State | Non-facility | Facility |
| --- | --- | --- |
| Alaska | $371.33 | $371.33 |
| District of Columbia | $305.95 | $305.95 |
| New York | $305.44 | $305.44 |
| New Jersey | $301.21 | $301.21 |
| Florida | $300.74 | $300.74 |
| Illinois | $298.08 | $298.08 |
| Connecticut | $294.43 | $294.43 |
| Washington | $292.31 | $292.31 |
| Massachusetts | $291.71 | $291.71 |
| California | $291.04 | $291.04 |
| Maryland | $287.95 | $287.95 |
| Michigan | $285.08 | $285.08 |
| Rhode Island | $284.59 | $284.59 |
| Colorado | $283.12 | $283.12 |
| Pennsylvania | $282.62 | $282.62 |
| Georgia | $282.04 | $282.04 |
| Hawaii | $281.75 | $281.75 |
| Puerto Rico | $281.36 | $281.36 |
| Virgin Islands | $281.36 | $281.36 |
| New Hampshire | $281.18 | $281.18 |
| Montana | $280.86 | $280.86 |
| West Virginia | $280.68 | $280.68 |
| Oregon | $280.44 | $280.44 |
| Texas | $279.39 | $279.39 |
| New Mexico | $279.27 | $279.27 |
| Delaware | $278.92 | $278.92 |
| Nevada | $277.51 | $277.51 |
| Louisiana | $275.80 | $275.80 |
| Arizona | $275.76 | $275.76 |
| Wyoming | $275.52 | $275.52 |
| Ohio | $274.99 | $274.99 |
| Missouri | $274.83 | $274.83 |
| Utah | $274.60 | $274.60 |
| Virginia | $273.63 | $273.63 |
| South Carolina | $272.49 | $272.49 |
| Kentucky | $271.39 | $271.39 |
| Maine | $270.06 | $270.06 |
| Vermont | $269.97 | $269.97 |
| Oklahoma | $268.81 | $268.81 |
| North Carolina | $268.75 | $268.75 |
| North Dakota | $268.60 | $268.60 |
| Minnesota | $268.35 | $268.35 |
| South Dakota | $267.15 | $267.15 |
| Mississippi | $265.79 | $265.79 |
| Indiana | $265.16 | $265.16 |
| Tennessee | $264.96 | $264.96 |
| Idaho | $264.40 | $264.40 |
| Kansas | $263.93 | $263.93 |
| Wisconsin | $263.64 | $263.64 |
| Alabama | $263.19 | $263.19 |
| Nebraska | $262.65 | $262.65 |
| Iowa | $262.48 | $262.48 |
| Arkansas | $261.02 | $261.02 |

## Related codes

- 40490: Biopsy of lip — https://www.med-reveal.com/rates/40490-cpt-fee-schedule
- 40650: Repair lip, vermilion only — https://www.med-reveal.com/rates/40650-cpt-fee-schedule
- 41010: Frenotomy, lingual — https://www.med-reveal.com/rates/41010-cpt-fee-schedule
- 41112: Excision of lesion of tongue — https://www.med-reveal.com/rates/41112-cpt-fee-schedule
- 41599: Unlisted procedure, tongue/floor of mouth — https://www.med-reveal.com/rates/41599-cpt-fee-schedule
- 42700: Incision and drainage of peritonsillar abscess — https://www.med-reveal.com/rates/42700-cpt-fee-schedule
- 42820: Tonsillectomy and adenoidectomy, under age 12 — https://www.med-reveal.com/rates/42820-cpt-fee-schedule
- 42821: Tonsillectomy and adenoidectomy, age 12 or over — https://www.med-reveal.com/rates/42821-cpt-fee-schedule

Commercial negotiated rates for 43260 by payer and state: https://www.med-reveal.com/solutions/rate-benchmarking

## Sources

- CMS Medicare fee schedules (2026 Q4): https://www.cms.gov/medicare/payment/fee-schedules