ERCP CPT Codes 43260–43278: Coding Sphincterotomy, Stones, Stents and Cholangioscopy

Every ERCP starts the same way, with the scope at the papilla and contrast in the ducts. What happens next decides the claim. ERCP CPT codes follow a simple structure: diagnostic ERCP CPT 43260 is the base, and each therapeutic step replaces or adds to it.

In short, sphincterotomy is 43262, stone removal is 43264 and stone destruction is 43265. Stent placement is 43274 per stent, removal is 43275 and exchange is 43276. Balloon dilation is 43277 per duct, ablation is 43278, and direct cholangioscopy adds +43273 once per session. Finally, the radiology supervision and interpretation codes 74328 to 74330 go on alongside them.

ERCP CPT Codes by Intervention

The table below maps all ERCP CPT codes to the work each one describes. Notice the unit column, because three codes are counted per stent or per duct rather than per session.

Also note the gap in the range. Codes 43266 through 43272 are not ERCP services, so a claim that pairs them with an ERCP usually signals a keying error.

Coding Sphincterotomy, Stones and Stents

Most ERCP billing questions come from three services that often happen together. Moreover, each one has a bundling rule that decides whether it stands alone.

43262 Sphincterotomy: When It Bundles

Code 43262 sphincterotomy stands alone when the cut opens the papilla for stone extraction, so 43262 and 43264 can both appear on the claim. However, CPT bars 43262 with a stent placement or exchange in the same location, because 43274 and 43276 already include sphincterotomy when performed. Similarly, balloon sphincteroplasty under 43277 absorbs a sphincterotomy at the same site. A pancreatic sphincterotomy alongside a biliary stent is a different location, so it can be reported with a distinct-site modifier.

43264 Stone Removal vs 43265 Lithotripsy

Use 43264 stone removal when balloon or basket sweeps clear stones or sludge. When stones are too large and the physician breaks them up first, 43265 lithotripsy applies instead, whether the method is mechanical, electrohydraulic or laser. Do not report both codes for the same stone, because 43265 already covers clearing the fragments.

43274 Biliary Stent, 43275 and 43276

Report code 43274 biliary stent placement once for each stent, since it includes guidewire passage and pre- or post-dilation. For 43275 43276 stent removal exchange choices, ask one question: did a new stent go in? If the old stent came out and nothing replaced it, use 43275. If a new stent replaced it in the same session, use 43276 for each stent exchanged and leave 43275 off.

Cholangioscopy, Balloon Dilation and Ablation Rules

These three services drive many edits on advanced ERCP claims. Follow these rules in order:

1. Add +43273 only once. The 43273 cholangioscopy add-on covers direct visualization of the bile or pancreatic duct and pairs with a primary ERCP code. Even if the physician scopes both ducts, the claim carries one unit.
2. Code 43277 balloon dilation per duct. So a dilated biliary stricture and a dilated pancreatic stricture are two units. In contrast, dilation that only prepares for a stent stays inside 43274.
3. Use 43278 for ablation. Radiofrequency or other ablation of a tumor or lesion is 43278, and it includes any dilation and guidewire work done for that ablation.
4. Match the primary code to the goal. For example, cholangioscopy with laser lithotripsy codes as 43265 plus +43273, not as a diagnostic 43260.

Billing Multiple ERCP CPT Codes in One Session

Therapeutic ERCPs rarely involve a single code. As a result, payment depends on two rules that sit outside the code descriptors.

The 43260 Base Code Rule

Medicare treats 43260 as the base code of the ERCP family under the special endoscopy rule. First, the highest-valued code pays in full. Then each additional ERCP code pays its own value minus the value of 43260, since every code already contains the diagnostic look. Therefore, a claim with 43262, 43264 and 43274 is not cut by 50% per line; instead, the base is subtracted once from each secondary code. For distinct-site cases, review the modifier 59 and X{EPSU} rules before submission.

Adding 74328, 74329 or 74330

Unlike some imaging-guided procedures, ERCP CPT codes do not include the fluoroscopic reading. Instead, the 74328 74329 74330 ERCP supervision and interpretation codes cover it: 74328 for the biliary system, 74329 for the pancreatic system and 74330 for both. When the gastroenterologist reads the images in a hospital, report the code with modifier 26 for the professional component only. If a radiologist reads them, the gastroenterologist leaves the S&I code off.

Worked Example: Stones Cleared, Stent Left In

A patient arrives with choledocholithiasis and obstruction, coded K80.51 under FY2027 ICD-10-CM. The gastroenterologist performs a biliary sphincterotomy and sweeps out two stones. However, one large stone remains, so a plastic biliary stent goes in to keep the duct draining. In addition, the physician reads the cholangiogram.

Codes billed: 43274, 43264 and 74328-26.

Why 43262 is missing: the sphincterotomy and the stent share the same location, so 43274 absorbs it.

How it pays: 43274 pays in full as the highest-valued code, while 43264 pays its value minus 43260.

Six weeks later, the patient returns for cholangioscopy-guided laser lithotripsy and stent removal. That visit codes as 43265, +43273 and 43275, again with 74328-26. For more GI scenarios, see our GI CPT code guide and the 2026 GI clinic code list.

Which ERCP Steps Earn Their Own Code

An ERCP note can list five or six steps, yet only some of them become separate lines. Sphincterotomy, dilation and guidewire work often fold into a stent code, while stones, stents, cholangioscopy and S&I usually stand on their own. Coding from the final result, duct by duct, keeps ERCP CPT codes accurate and payments predictable. Clean coding also shortens the payment cycle, as one GI practice that cut A/R by 42 days found. For coder review of advanced endoscopy claims, explore our gastroenterology billing services.

ERCP CPT Codes FAQs