CPT 43262

Ercp W/Sphincterotomy/Papillotomy

CPT 43262 pays $311.30 in a non-facility setting and $311.30 in a facility setting under the 2026 Medicare Physician Fee Schedule, before geographic adjustment. After geographic adjustment, state amounts run from $289.22 in Arkansas to $411.63 in Alaska, a 42% spread.

National non-facility rate

$311.30

Office and other outpatient settings

Facility rate
$311.30

Hospital and ASC settings

Highest state
$411.63

Alaska

Lowest state
$289.22

Arkansas · 42% spread

Medicare rate by state

53 Medicare jurisdictions, highest to lowest. State values average every locality in the jurisdiction at a 33.4009 conversion factor.

Non-facilityFacilityNational $311.30
CPT 43262 Medicare reimbursement rate by state, 33.4009 conversion factor, 2026 Physician Fee Schedule. National non-facility $311.30, national facility $311.30.
StateRate compared visuallyNon-facilityFacility
Alaska
$411.63$411.63
District of Columbia
$338.93$338.93
New York
$338.54$338.54
New Jersey
$333.73$333.73
Florida
$333.68$333.68
Illinois
$330.77$330.77
Connecticut
$326.31$326.31
Washington
$323.70$323.70
Massachusetts
$323.08$323.08
California
$322.14$322.14
Maryland
$319.10$319.10
Michigan
$316.18$316.18
Rhode Island
$315.31$315.31
Colorado
$313.59$313.59
Pennsylvania
$313.25$313.25
Georgia
$312.71$312.71
Hawaii
$311.89$311.89
Puerto Rico
$311.78$311.78
Virgin Islands
$311.78$311.78
New Hampshire
$311.50$311.50
West Virginia
$311.40$311.40
Montana
$311.25$311.25
Oregon
$310.60$310.60
New Mexico
$309.68$309.68
Texas
$309.62$309.62
Delaware
$309.08$309.08
Nevada
$307.47$307.47
Louisiana
$305.77$305.77
Arizona
$305.57$305.57
Wyoming
$305.22$305.22
Ohio
$304.86$304.86
Missouri
$304.66$304.66
Utah
$304.34$304.34
Virginia
$303.13$303.13
South Carolina
$302.00$302.00
Kentucky
$300.86$300.86
Maine
$299.17$299.17
Vermont
$298.98$298.98
Oklahoma
$297.93$297.93
North Carolina
$297.75$297.75
North Dakota
$297.41$297.41
Minnesota
$297.04$297.04
South Dakota
$295.77$295.77
Mississippi
$294.61$294.61
Indiana
$293.72$293.72
Tennessee
$293.54$293.54
Idaho
$292.88$292.88
Kansas
$292.39$292.39
Wisconsin
$291.92$291.92
Alabama
$291.63$291.63
Nebraska
$290.89$290.89
Iowa
$290.72$290.72
Arkansas
$289.22$289.22

Billed by 1 specialties

Commercial rates for 43262

Medicare is the floor, not the market. See what UHC, Aetna, Cigna and BCBS actually pay — down to the TIN.

See negotiated rates