CPT 43263

Ercp W/Pressure Measurement Sphincter of Oddi

CPT 43263 pays $311.96 in a non-facility setting and $311.96 in a facility setting under the 2026 Medicare Physician Fee Schedule, before geographic adjustment. After geographic adjustment, state amounts run from $289.79 in Arkansas to $412.34 in Alaska, a 42% spread.

National non-facility rate

$311.96

Office and other outpatient settings

Facility rate
$311.96

Hospital and ASC settings

Highest state
$412.34

Alaska

Lowest state
$289.79

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 $311.96
CPT 43263 Medicare reimbursement rate by state, 33.4009 conversion factor, 2026 Physician Fee Schedule. National non-facility $311.96, national facility $311.96.
StateRate compared visuallyNon-facilityFacility
Alaska
$412.34$412.34
District of Columbia
$339.72$339.72
New York
$339.29$339.29
New Jersey
$334.48$334.48
Florida
$334.35$334.35
Illinois
$331.41$331.41
Connecticut
$327.02$327.02
Washington
$324.46$324.46
Massachusetts
$323.83$323.83
California
$322.93$322.93
Maryland
$319.79$319.79
Michigan
$316.81$316.81
Rhode Island
$316.00$316.00
Colorado
$314.30$314.30
Pennsylvania
$313.91$313.91
Georgia
$313.34$313.34
Hawaii
$312.65$312.65
Puerto Rico
$312.46$312.46
Virgin Islands
$312.46$312.46
New Hampshire
$312.19$312.19
West Virginia
$311.98$311.98
Montana
$311.92$311.92
Oregon
$311.30$311.30
New Mexico
$310.29$310.29
Texas
$310.28$310.28
Delaware
$309.74$309.74
Nevada
$308.14$308.14
Louisiana
$306.38$306.38
Arizona
$306.22$306.22
Wyoming
$305.89$305.89
Ohio
$305.47$305.47
Missouri
$305.27$305.27
Utah
$304.97$304.97
Virginia
$303.78$303.78
South Carolina
$302.62$302.62
Kentucky
$301.45$301.45
Maine
$299.81$299.81
Vermont
$299.65$299.65
Oklahoma
$298.53$298.53
North Carolina
$298.38$298.38
North Dakota
$298.08$298.08
Minnesota
$297.73$297.73
South Dakota
$296.44$296.44
Mississippi
$295.18$295.18
Indiana
$294.34$294.34
Tennessee
$294.15$294.15
Idaho
$293.50$293.50
Kansas
$292.99$292.99
Wisconsin
$292.56$292.56
Alabama
$292.21$292.21
Nebraska
$291.51$291.51
Iowa
$291.34$291.34
Arkansas
$289.79$289.79

Billed by 1 specialties

Commercial rates for 43263

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

See negotiated rates