# CPT 43262: ERCP with sphincterotomy

Medicare 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.

Web page: https://www.med-reveal.com/rates/43262-cpt-fee-schedule
Section: Surgery and Procedures
Billed by: Gastroenterology

## Medicare rates

| | Amount |
| --- | --- |
| National non-facility | $311.30 |
| National facility | $311.30 |
| Conversion factor | 33.4009 |
| Release | 2026 Q4 (effective 2026-10-01) |

## By state

| State | Non-facility | Facility |
| --- | --- | --- |
| 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 | $333.69 | $333.69 |
| 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 | $313.26 | $313.26 |
| 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 | $299.18 | $299.18 |
| 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 |

## 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 43262 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