How much does Medicare pay for CPT 43275?

Medicare allowed an average of $327.65 per service and paid $255.40 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $1430.20, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 43275?

Removal of stent from pancreatic or bile duct using a flexible endoscope. It was billed 5,613 times to 5,484 Medicare beneficiaries by 289 providers in 2024.

Which specialty bills 43275 most?

Gastroenterology, with 5,208 services from 269 clinicians. Next are Internal Medicine, General Surgery, Surgical Oncology.

CPT 43275

Removal of stent from pancreatic or bile duct using a flexible endoscope

$327.65Medicare-allowed amount per service, averaged across 5,613 services

Providers submitted

$1430.20

Asking price, not received

Medicare allowed

$327.65

The fee schedule figure

Medicare paid

$255.40

Balance is patient coinsurance

Providers submitted an average of $1430.20 for this code and Medicare allowed $327.65 — 4.4× 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 $255.40 (78%); the rest is the patient’s coinsurance and deductible.

Services: 5,613
Beneficiaries: 5,484
Providers billing it: 289
Total allowed: $1,839,099

What Medicare pays for CPT 43275

Across 5,613 services billed by 289 providers to 5,484 beneficiaries, Medicare allowed an average of $327.65 per service. 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 43275

Specialty	Services	Beneficiaries	Avg allowed	Providers
Gastroenterology	5,208	5,083	$326.04	269
Internal Medicine	268	266	$345.73	14
General Surgery	93	92	$317.84	4
Surgical Oncology	31	30	$318.62	1
Ambulatory Surgical Center	13	13	$692.75	1

43275 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
Missouri	541	$334.57	$267.20	18
California	454	$322.10	$225.69	24
Illinois	316	$329.74	$240.88	17
Massachusetts	284	$348.55	$250.91	14
Florida	252	$328.02	$244.06	13
Texas	250	$320.86	$248.42	16
Virginia	241	$340.73	$256.70	12
South Carolina	233	$257.50	$196.40	9
Pennsylvania	207	$327.61	$250.18	15
Colorado	204	$344.06	$265.17	7
North Carolina	195	$290.34	$224.62	9
Ohio	189	$327.75	$256.27	12
Washington	182	$333.32	$243.24	11
New York	169	$397.44	$273.16	11
Maryland	162	$341.31	$243.42	9
Arizona	157	$332.87	$265.49	7
Kentucky	156	$293.42	$223.82	6
Michigan	143	$329.81	$250.83	9
Louisiana	120	$297.57	$241.90	6
Indiana	105	$291.20	$232.26	6
New Jersey	98	$378.43	$271.49	5
District of Columbia	83	$408.28	$269.56	3
Oklahoma	76	$307.17	$250.06	3
Arkansas	72	$317.79	$258.63	4
West Virginia	72	$340.16	$260.64	5
Nebraska	66	$306.06	$254.94	4
Iowa	64	$308.34	$248.71	2
Wisconsin	50	$344.53	$262.25	2
Kansas	46	$327.81	$258.52	2
Minnesota	44	$328.15	$254.56	3
Nevada	43	$266.61	$198.07	3
North Dakota	38	$349.70	$283.21	2
Georgia	38	$351.11	$264.85	3
Utah	33	$315.92	$243.02	2
South Dakota	32	$343.97	$284.16	2
Tennessee	31	$245.27	$202.01	2
Idaho	27	$251.19	$224.29	1
Mississippi	26	$280.46	$223.85	2
New Hampshire	17	$344.57	$272.54	1
Connecticut	17	$382.83	$276.72	1
Oregon	16	$361.47	$288.61	1
Maine	14	$305.10	$219.28	1
Alabama	13	$229.03	$185.27	1
Alaska	13	$692.75	$376.20	1
Delaware	13	$364.32	$288.18	1
New Mexico	11	$348.22	$249.88	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.