# CPT 43265: Ercp Destruction/lithotripsy Calculi Any Method

Medicare 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.

Web page: https://www.med-reveal.com/rates/43265-cpt-fee-schedule
Section: Surgery and Procedures
Billed by: Gastroenterology

## Medicare rates

| | Amount |
| --- | --- |
| National non-facility | $376.76 |
| National facility | $376.76 |
| Conversion factor | 33.4009 |
| Release | 2026 Q4 (effective 2026-10-01) |

## By state

| State | Non-facility | Facility |
| --- | --- | --- |
| 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 | $368.93 | $368.93 |
| 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 |

## 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 43265 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