# CPT 43261: Ercp W/biopsy Single/multiple

Medicare CPT 43261 pays $295.60 in a non-facility setting and $295.60 in a facility setting under the 2026 Medicare Physician Fee Schedule, before geographic adjustment. After geographic adjustment, state amounts run from $274.48 in Arkansas to $390.49 in Alaska, a 42% spread.

Web page: https://www.med-reveal.com/rates/43261-cpt-fee-schedule
Section: Surgery and Procedures
Billed by: Gastroenterology

## Medicare rates

| | Amount |
| --- | --- |
| National non-facility | $295.60 |
| National facility | $295.60 |
| Conversion factor | 33.4009 |
| Release | 2026 Q4 (effective 2026-10-01) |

## By state

| State | Non-facility | Facility |
| --- | --- | --- |
| Alaska | $390.49 | $390.49 |
| District of Columbia | $321.91 | $321.91 |
| New York | $321.56 | $321.56 |
| Florida | $317.03 | $317.03 |
| New Jersey | $316.94 | $316.94 |
| Illinois | $314.23 | $314.23 |
| Connecticut | $309.91 | $309.91 |
| Washington | $307.38 | $307.38 |
| Massachusetts | $306.80 | $306.80 |
| California | $305.88 | $305.88 |
| Maryland | $303.03 | $303.03 |
| Michigan | $300.27 | $300.27 |
| Rhode Island | $299.39 | $299.39 |
| Colorado | $297.76 | $297.76 |
| Pennsylvania | $297.46 | $297.46 |
| Georgia | $296.95 | $296.95 |
| Hawaii | $296.15 | $296.15 |
| Puerto Rico | $296.06 | $296.06 |
| Virgin Islands | $296.06 | $296.06 |
| New Hampshire | $295.79 | $295.79 |
| West Virginia | $295.70 | $295.70 |
| Montana | $295.55 | $295.55 |
| Oregon | $294.91 | $294.91 |
| New Mexico | $294.05 | $294.05 |
| Texas | $293.98 | $293.98 |
| Delaware | $293.47 | $293.47 |
| Nevada | $291.93 | $291.93 |
| Louisiana | $290.32 | $290.32 |
| Arizona | $290.12 | $290.12 |
| Wyoming | $289.78 | $289.78 |
| Ohio | $289.44 | $289.44 |
| Missouri | $289.25 | $289.25 |
| Utah | $288.95 | $288.95 |
| Virginia | $287.78 | $287.78 |
| South Carolina | $286.71 | $286.71 |
| Kentucky | $285.61 | $285.61 |
| Maine | $284.00 | $284.00 |
| Vermont | $283.81 | $283.81 |
| Oklahoma | $282.82 | $282.82 |
| North Carolina | $282.64 | $282.64 |
| North Dakota | $282.31 | $282.31 |
| Minnesota | $281.96 | $281.96 |
| South Dakota | $280.74 | $280.74 |
| Mississippi | $279.64 | $279.64 |
| Indiana | $278.78 | $278.78 |
| Tennessee | $278.61 | $278.61 |
| Idaho | $277.98 | $277.98 |
| Kansas | $277.51 | $277.51 |
| Wisconsin | $277.05 | $277.05 |
| Alabama | $276.78 | $276.78 |
| Nebraska | $276.07 | $276.07 |
| Iowa | $275.91 | $275.91 |
| Arkansas | $274.48 | $274.48 |

## Related codes

- 10140: I&d Hematoma Seroma/fluid Collection — https://www.med-reveal.com/rates/10140-cpt-fee-schedule
- 11055: Paring/cutting Benign Hyperkeratotic Lesion 1 — https://www.med-reveal.com/rates/11055-cpt-fee-schedule
- 11056: Paring/cutting Benign Hyperkeratotic Lesion 2-4 — https://www.med-reveal.com/rates/11056-cpt-fee-schedule
- 11057: Paring/cutting Benign Hyperkeratotic Lesion >4 — https://www.med-reveal.com/rates/11057-cpt-fee-schedule
- 11403: Exc B9 Lesion Mrgn Xcp Sk Tg T/a/l 2.1-3.0 Cm — https://www.med-reveal.com/rates/11403-cpt-fee-schedule
- 11404: Exc B9 Lesion Mrgn Xcp Sk Tg T/a/l 3.1-4.0 Cm — https://www.med-reveal.com/rates/11404-cpt-fee-schedule
- 11406: Exc B9 Lesion Mrgn Xcp Sk Tg T/a/l >4.0 Cm — https://www.med-reveal.com/rates/11406-cpt-fee-schedule
- 11603: Excision Mal Lesion Trunk/arm/leg 2.1-3.0 Cm — https://www.med-reveal.com/rates/11603-cpt-fee-schedule

Commercial negotiated rates for 43261 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