CPT 43265

Ercp Destruction/Lithotripsy Calculi Any Method

CPT 43265 pays $376.76 in a non-facility setting and $376.76 in a facility setting under the 2026 Medicare Physician Fee Schedule, before geographic adjustment. After geographic adjustment, state amounts run from $350.05 in Arkansas to $498.63 in Alaska, a 42% spread.

National non-facility rate

$376.76

Office and other outpatient settings

Facility rate
$376.76

Hospital and ASC settings

Highest state
$498.63

Alaska

Lowest state
$350.05

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 $376.76
CPT 43265 Medicare reimbursement rate by state, 33.4009 conversion factor, 2026 Physician Fee Schedule. National non-facility $376.76, national facility $376.76.
StateRate compared visuallyNon-facilityFacility
Alaska
$498.63$498.63
District of Columbia
$409.92$409.92
New York
$409.80$409.80
Florida
$404.57$404.57
New Jersey
$403.74$403.74
Illinois
$401.12$401.12
Connecticut
$394.92$394.92
Washington
$391.30$391.30
Massachusetts
$390.63$390.63
California
$389.12$389.12
Maryland
$386.18$386.18
Michigan
$383.14$383.14
Rhode Island
$381.48$381.48
Pennsylvania
$379.26$379.26
Colorado
$379.23$379.23
Georgia
$378.74$378.74
West Virginia
$377.56$377.56
Puerto Rico
$377.31$377.31
Virgin Islands
$377.31$377.31
New Hampshire
$376.80$376.80
Hawaii
$376.79$376.79
Montana
$376.70$376.70
Oregon
$375.58$375.58
New Mexico
$375.17$375.17
Texas
$374.73$374.73
Delaware
$374.04$374.04
Nevada
$372.00$372.00
Louisiana
$370.34$370.34
Arizona
$369.80$369.80
Ohio
$369.21$369.21
Wyoming
$369.21$369.21
Missouri
$368.94$368.94
Utah
$368.43$368.43
Virginia
$366.70$366.70
South Carolina
$365.60$365.60
Kentucky
$364.36$364.36
Maine
$361.93$361.93
Vermont
$361.51$361.51
Oklahoma
$360.70$360.70
North Carolina
$360.27$360.27
North Dakota
$359.50$359.50
Minnesota
$358.90$358.90
South Dakota
$357.47$357.47
Mississippi
$356.74$356.74
Indiana
$355.29$355.29
Tennessee
$355.16$355.16
Idaho
$354.29$354.29
Kansas
$353.76$353.76
Alabama
$352.96$352.96
Wisconsin
$352.89$352.89
Nebraska
$351.79$351.79
Iowa
$351.63$351.63
Arkansas
$350.05$350.05

Billed by 1 specialties

Commercial rates for 43265

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

See negotiated rates