43265 Ercp lithotripsy calculi
Also known as: ERCP lithotripsy, pancreatic lithotripsy, biliary stone fragmentation
Endoscopic retrograde cholangiopancreatography with extracorporeal shock wave lithotripsy of pancreatic or biliary ductal calculi for fragmentation. This therapeutic procedure fragments large stones.
In Plain Language
shock wave treatment to break stones; stone fragmentation
Clinical Context
Used for large intrahepatic or choledochal stones that cannot be extracted intact; fragments enable subsequent extraction and reduce complications.
RVU Breakdown
| Work RVU | 7.73 |
| Total RVU | 7.73 |
Est. Medicare Payment
National estimate based on 2026 CMS PFS Conversion Factor ($33.40). Actual payment varies by locality (GPCI adjustment).
Billing & Documentation
As a surgical CPT code, proper documentation must include the operative report detailing the procedure performed, patient positioning, approach, findings, and any complications. This code has a 0-day global period, meaning pre- and post-operative E&M visits are billable separately on the same day. Ensure the diagnosis code (ICD-10) supports medical necessity for the procedure.
How This Code Compares
With a work RVU of 7.73, this code ranks in the 49th percentile among Surgery codes — 1.0x below the median (8.00). The highest wRVU in this category is 106.19.
Specialties
Frequently Asked Questions
What is CPT code 43265?
CPT 43265 (Ercp lithotripsy calculi) is a Surgery code. Endoscopic retrograde cholangiopancreatography with extracorporeal shock wave lithotripsy of pancreatic or biliary ductal calculi for fragmentation. This therapeutic procedure fragments large stones.
What is the wRVU value for CPT 43265?
The work RVU for CPT 43265 is 7.73. This code is primarily used by Gastroenterology, Surgery, Urology.
When is CPT 43265 used?
Used for large intrahepatic or choledochal stones that cannot be extracted intact; fragments enable subsequent extraction and reduce complications.
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CPT® is a registered trademark of the American Medical Association. Data sourced from CMS Physician Fee Schedule RVU26A. Descriptions, synonyms, and clinical context are original content by RVU Edge.