# CPT 43263: Ercp W/pressure Measurement Sphincter of Oddi

Medicare 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.

Web page: https://www.med-reveal.com/rates/43263-cpt-fee-schedule
Section: Surgery and Procedures
Billed by: Gastroenterology

## Medicare rates

| | Amount |
| --- | --- |
| National non-facility | $311.96 |
| National facility | $311.96 |
| Conversion factor | 33.4009 |
| Release | 2026 Q4 (effective 2026-10-01) |

## By state

| State | Non-facility | Facility |
| --- | --- | --- |
| 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 | $313.35 | $313.35 |
| 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 | $310.27 | $310.27 |
| 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 | $299.82 | $299.82 |
| 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 |

## 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 43263 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