How much does Medicare pay for CPT 43273?

Medicare allowed an average of $116.63 per service and paid $93.21 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $527.49, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 43273?

Exam of common bile and/or pancreatic duct using a flexible endoscope. It was billed 4,265 times to 3,460 Medicare beneficiaries by 143 providers in 2024.

Which specialty bills 43273 most?

Gastroenterology, with 4,124 services from 135 clinicians. Next are Internal Medicine, General Surgery.

CPT 43273

Exam of common bile and/or pancreatic duct using a flexible endoscope

$116.63Medicare-allowed amount per service, averaged across 4,265 services

Providers submitted

$527.49

Asking price, not received

Medicare allowed

$116.63

The fee schedule figure

Medicare paid

$93.21

Balance is patient coinsurance

Providers submitted an average of $527.49 for this code and Medicare allowed $116.63 — 4.5× less. That gap is normal and means nothing on its own: Medicare pays its fee schedule regardless of what is billed, so the submitted figure describes a hospital chargemaster, not a price anyone paid. Of the allowed amount Medicare paid $93.21 (80%); the rest is the patient’s coinsurance and deductible.

Services: 4,265
Beneficiaries: 3,460
Providers billing it: 143
Total allowed: $497,427

What Medicare pays for CPT 43273

Across 4,265 services billed by 143 providers to 3,460 beneficiaries, Medicare allowed an average of $116.63 per service. That is 1.2 services per beneficiary, so this is a code patients typically receive more than once. The allowed amount is the figure that matters: it is what Medicare and the patient together owe, set by the fee schedule and adjusted for local practice costs. What a provider chose to submit has no bearing on it.

Who bills 43273

Specialty	Services	Beneficiaries	Avg allowed	Providers
Gastroenterology	4,124	3,331	$116.65	135
Internal Medicine	123	113	$117.08	7
General Surgery	18	16	$109.44	1

43273 reimbursement by state

Two different numbers. Allowed is what Medicare actually allowed in that state, which includes the local practice-cost adjustment. Standardized strips that geographic adjustment out of the payment, so it is the column to use when comparing states — a difference there reflects how the code was billed, not what it costs to run a practice locally.

State	Services	Allowed	Standardized pmt	Providers
Arizona	751	$111.64	$91.25	6
California	400	$124.33	$91.15	13
New Jersey	275	$126.17	$91.13	8
Illinois	240	$123.05	$91.11	6
Texas	237	$116.70	$91.09	12
New York	214	$126.76	$91.02	9
Florida	210	$119.65	$91.08	10
Massachusetts	190	$123.14	$91.02	8
Indiana	169	$107.34	$91.32	7
Oklahoma	142	$109.90	$91.29	3
Missouri	137	$112.30	$90.97	6
Michigan	125	$115.97	$91.19	3
Ohio	104	$118.82	$91.18	3
Wisconsin	97	$110.64	$91.34	2
Pennsylvania	93	$115.77	$91.32	6
Virginia	91	$116.16	$91.11	4
North Carolina	89	$110.23	$91.44	4
South Carolina	88	$110.36	$91.10	4
South Dakota	68	$108.59	$91.46	1
Kentucky	67	$108.99	$92.32	3
Tennessee	56	$107.07	$91.10	1
Colorado	48	$115.98	$91.00	3
Maine	42	$112.49	$91.12	2
Nebraska	40	$106.39	$91.69	3
Delaware	39	$114.61	$91.34	3
Nevada	37	$113.46	$91.80	2
Georgia	37	$113.75	$91.22	2
West Virginia	34	$109.63	$92.01	1
Maryland	31	$121.17	$91.24	1
Arkansas	30	$107.10	$91.09	2
Alaska	20	$150.01	$91.04	1
Kansas	19	$107.37	$91.10	1
Alabama	16	$108.56	$91.34	1
Minnesota	15	$110.26	$91.13	1
Iowa	14	$107.17	$91.34	1

Related codes

43239Biopsy of esophagus$167.49
43235Diagnostic exam of esophagus$145.31
43249Balloon dilation of esophagus$337.40
43248Insertion of guide wire$223.15
43264Removal of stone or debris from bile or pancreatic duct$135.60
43251Removal of polyps or growths of esophagus$419.64
43274Insertion of stent into pancreatic or bile duct$392.61
43259Ultrasound exam of esophagus$230.50
43242Ultrasound guided needle aspiration or biopsy of esophagus$249.98
43255Control of bleeding of esophagus$200.78
43237Ultrasound exam of esophagus$204.08
43246Insertion of stomach tube$194.27

Billing this code is not the same as earning it

An allowed amount is revenue to a practice, not income to a clinician. It funds staff, premises, equipment and supplies before anyone is paid. What clinicians actually earn is published separately by the Department of Labor, and what industry pays them is published separately again by CMS — this site carries both.

What doctors are paid →·Look up a clinician →·All procedure codes →

Where this comes from. CMS Medicare Physician & Other Practitioners, by Provider and Service, 2024. It covers fee-for-service Original Medicare Part B only — not Medicare Advantage, not Medicaid, and not commercial insurance, which typically pays more for the same code.

How it is averaged. CMS publishes one average per provider per code. Every figure here is re-weighted by the number of services, so a clinician who billed the code 4,000 times counts 4,000 times more than one who billed it twice. CMS also suppresses any provider-code pair with fewer than 11 beneficiaries, so low-volume practice is missing from these totals by design.