Sunday, August 1, 2010

ENDOSCOPIC RETROGRADE CPT code and payment

2010 Medicare GI Endoscopy Procedure Reimbursement Guide for ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY



ENDOSCOPIC RETROGRADE
CHOLANGIOPANCREATOGRAPHY
Ambulatory
Surgery Center
Outpatient
Hospital
Physician
Services
Code Procedure Description ASC Facility Fee
(National Medicare Avg)
APC Facility Fee
Schedule
(National Medicare Avg)²
Fee When
Procedure
Performed in
Hospital or ASC
(National Medicare Avg)³
Fee When
Procedure
Performed
in Office
(National Medicare Avg)³
43260  Endoscopic retrograde cholangiopancreatography (ERCP); diagnostic, with or without collection of specimen(s) by   brushing or washing (separate procedure)    $786.01    0151    $1,524.12    $344.97    NA*  
43261  ...with biopsy, single or multiple    $786.01    0151    $1,524.12    $362.29    NA*  
43262  …with sphincterotomy/papillotomy    $786.01    0151    $1,524.12    $425.08    NA*  
43263  ...with pressure measurement of sphincter of Oddi (pancreatic duct or common bile duct)    $786.01    0151    $1,524.12    $420.02    NA*  
43264  …with endoscopic retrograde removal of calculus/calculi from biliary and/or   pancreatic ducts    $786.01    0151    $1,524.12    $510.96    NA*  
43265  …with endoscopic retrograde destruction, lithotripsy of calculus/calculi, any method    $786.01    0151    $1,524.12    $573.75    NA*  
43267  ...with endoscopic retrograde insertion of nasobiliary or nasopancreatic drainage tube    $786.01    0151    $1,524.12    $423.63    NA*  
43268  ...with endoscopic retrograde insertion of tube or stent into bile or pancreatic duct    $902.60    0384    $1,785.67    $430.13    NA*  
43269  ...with endoscopic retrograde removal of foreign body and/or change of tube or stent    $902.60    0384    $1,785.67    $471.99    NA*  
43271  ... with endoscopic retrograde balloon dilation of ampulla, biliary and/or pancreatic duct(s)    $786.01    0151    $1,524.12    $424.72    NA*  
43272  ...with ablation of tumor(s), polyp(s), or other lesion(s) not amenable to removal by hot biopsy forceps, bipolar cautery or   snare technique    $786.01    0151    $1,524.12    $424.34    NA*  

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