# Ercp: Cost, Coverage, and What to Expect

Source: https://ourhealthnetwork.com/procedure-costs/ercp
Last reviewed: 2026-04-19
Data: CMS Hospital and Outpatient pricing, CPT/HCPCS code mapping

## Quick answer

Medicare pays the gastroenterologist about $316 for an ERCP with stent work, but the total hospital bill for a commercial patient typically runs $8,000 to $20,000 once facility, anesthesia, and supplies are added.

## What it is

ERCP stands for endoscopic retrograde cholangiopancreatography. It is a procedure that combines a flexible scope passed down through your mouth with X-ray imaging to look at the bile ducts and pancreatic duct. When those ducts get blocked by gallstones, scar tissue, or tumors, an ERCP lets the doctor see the blockage and treat it in the same visit. Most often, that treatment is placing a small tube called a stent that holds the duct open so bile or pancreatic fluid can drain normally.

- **Duration:** 30 to 90 minutes, depending on what the doctor finds and treats
- **Anesthesia:** Deep sedation or general anesthesia, given by an anesthesiologist or CRNA
- **Setting:** Almost always a hospital outpatient department or ambulatory surgery center, very rarely an office
- **Recovery on-site:** 1 to 2 hours in a recovery bay before you go home
- **Hospital stay:** Usually none, unless you came in through the ER or have complications

This page covers two related procedures that often get billed together. Code 43274 is the placement of a stent into the bile or pancreatic duct. Code 43275 is the later removal or exchange of that stent, usually 6 to 12 weeks later. Many patients end up needing both, which means two separate procedures and two separate bills over a few months.

## When it is done

ERCP is not a screening test. It is a targeted procedure done when imaging or blood work has already pointed to a problem in the bile or pancreatic ducts. Doctors generally try less invasive imaging first, like MRCP (an MRI of the ducts) or an abdominal ultrasound, because ERCP carries a real risk of pancreatitis afterward.

Your doctor may recommend ERCP with stent placement when:

1. A gallstone is stuck in the common bile duct and causing pain, jaundice, or infection
2. Tumors of the pancreas, bile duct, or ampulla are blocking drainage
3. A bile duct has narrowed from chronic pancreatitis or prior surgery
4. There is a bile leak after gallbladder surgery or liver transplant
5. You have unexplained jaundice with abnormal liver enzymes pointing to a duct problem
6. Pancreatic duct strictures or stones are causing recurrent pancreatitis

Stent removal or exchange (43275) is scheduled separately, usually 6 to 12 weeks after placement. Plastic stents need to come out or be swapped to avoid clogging. Metal stents may stay in longer or permanently, depending on the diagnosis.

## What you pay

Here is the honest picture: the gastroenterologist's fee is the smallest part of an ERCP bill. Medicare pays the doctor around $316, but the facility, anesthesia, and stent itself are billed separately and add thousands more. Commercial insurers typically pay the facility 2 to 4 times what Medicare would pay, which is why a commercial total bill can land between $8,000 and $20,000 even though the physician slice looks modest.

**If you're on Medicare:**

- Part B covers the physician fee. After your $257 Part B deductible (2025 figure), you pay 20 percent coinsurance on the doctor's services.
- The facility fee is paid through Part B as a hospital outpatient or ASC service. Your share is also coinsurance, capped by the inpatient deductible amount per service in 2025.
- A Medigap or Medicare Advantage plan usually covers most or all of your 20 percent share.
- If you are admitted overnight for complications, Part A kicks in with the $1,676 inpatient deductible (2025 figure).

**If you have commercial insurance:**

- Expect the facility to bill $6,000 to $15,000, the physician $1,500 to $3,000, and anesthesia $800 to $2,000.
- After your deductible and coinsurance, your out-of-pocket is usually $1,500 to $4,000, capped by your annual out-of-pocket maximum.
- Verify in-network status for the surgeon, the facility, the anesthesiologist, and any pathologist before the procedure.
- Stent type matters. A self-expanding metal stent can add $2,000 to $5,000 to the bill compared with a plastic stent.

**If you're uninsured or paying cash:**

- Ask for a bundled cash-pay rate that combines facility, physician, and anesthesia. Negotiated cash rates often run $5,000 to $12,000.
- Hospitals must offer a Good Faith Estimate under federal law if you tell them you are self-pay.
- Apply for the hospital's financial assistance or charity care program before the procedure if your income qualifies.
- Ambulatory surgery centers are often 30 to 50 percent cheaper than hospital outpatient departments for the same code.

## Anatomy of the bill

An ERCP bill is rarely a single line item. It is usually four or five separate charges from different providers, often arriving over several weeks. Knowing each piece helps you spot errors and know what to negotiate.

**Physician fee (gastroenterologist):** The doctor doing the scope bills for their professional work using code 43274 or 43275. Medicare pays around $316; commercial insurers typically pay $1,500 to $3,000.

**Facility fee:** This is the largest single charge. The hospital outpatient department or ASC bills for the room, equipment, nursing, and recovery time. Commercial facility fees commonly run $6,000 to $15,000; Medicare pays a fixed APC rate that is much lower.

**Anesthesia fee:** An anesthesiologist or CRNA bills separately for sedation. Expect $800 to $2,000 commercial. This is one of the most common surprise-billing sources because the anesthesia group may not be in your insurance network even when the hospital is.

**Stent and supplies:** The stent itself is sometimes itemized. Plastic stents are inexpensive; metal stents can add $2,000 to $5,000 to the bill.

**Pre-procedure imaging and labs:** MRCP, ultrasound, blood work, and a clinic visit before the procedure each generate their own bills.

**Pathology:** If the doctor takes a biopsy or brushes the duct for cells, a pathologist bills separately, usually $200 to $600.

**Follow-up and stent removal:** A second ERCP to remove or exchange the stent is its own procedure with its own facility, physician, and anesthesia bills 6 to 12 weeks later.

## Cost by state

Medicare physician payments for ERCP vary modestly by state because Medicare uses a geographic adjustment formula. Iowa is the lowest-paying state in the data at about $266 per service, while Alaska is the highest at $361. Most states cluster in a tight $290 to $340 range. The high-volume states are Illinois (7,367 services), California (7,026), and Michigan (5,351), reflecting where the largest GI practices and tertiary referral centers are concentrated.

State-level variation in the physician fee is small compared with the swings you will see in the facility fee, which Medicare data does not capture here. A commercial facility bill in New York City or San Francisco can be 2 to 3 times what the same procedure costs in a midsized Midwestern city.

**Why costs vary by state:**

- Medicare uses a Geographic Practice Cost Index that adjusts payment for local wages, rent, and malpractice premiums
- Commercial insurers negotiate facility rates locally, and large hospital systems with market power often command much higher prices
- Cost of living and labor markets drive baseline salaries for the GI team, anesthesiologist, and nursing staff
- State surprise-billing laws and arbitration rules affect what out-of-network providers can collect

## Office vs facility

ERCP is essentially never done in a physician office. Medicare data shows 32,921 services performed in facility settings versus just 21 in an office setting, from a single provider. The procedure requires fluoroscopy, deep sedation, and immediate access to surgical and interventional radiology backup, which is why it lives in hospitals and ASCs.

The real choice for most patients is hospital outpatient department versus ambulatory surgery center. Both are facility settings, but the price tags can be very different.

**Hospital outpatient vs ambulatory surgery center, what to weigh:**

- ASCs are often 30 to 50 percent cheaper for the same procedure code, and out-of-pocket is usually lower
- Hospital outpatient is the safer choice if you have significant heart, lung, or bleeding risk, or if your case is complex (tumor, prior surgery, suspected cancer)
- ASCs work well for routine stent removals (43275) and straightforward stone or stricture cases
- Inpatient admission is required only if you came in through the ER, have ongoing infection, or develop a complication after the procedure

## Who performs the procedure

ERCP is one of the most technically demanding procedures in gastroenterology. The data confirms what you would expect: 924 of the 976 providers in the file are gastroenterologists, accounting for the overwhelming majority of services. A small number of internal medicine physicians appear (47 providers, ~3 percent of services), but in practice ERCP is essentially a GI subspecialty procedure.

Within gastroenterology, there is a meaningful skill gradient. High-volume ERCP endoscopists, often called advanced or therapeutic endoscopists, complete an extra year of fellowship training and do hundreds of cases a year. Lower-volume operators have higher complication rates and lower success rates for difficult cases.

**What to look for when choosing a specialist:**

- Annual ERCP volume of at least 100 cases for the individual physician
- Advanced endoscopy or therapeutic endoscopy fellowship training, especially for complex cases
- Board certification in gastroenterology
- Cannulation success rate the doctor can quote (top operators are above 95 percent)
- Affiliation with a hospital that has interventional radiology and surgery backup if a complication occurs
- For tumors or complex strictures, a center that performs at least 200 ERCPs per year

The small internal medicine count in the data likely reflects hospitalist or consulting roles in inpatient cases, not primary endoscopists. Always confirm your operator's GI training and ERCP experience directly.

## How to shop for the best price

ERCP bills are notoriously messy because four or five separate providers each bill independently. A little legwork before the procedure can save thousands.

1. **Request a Good Faith Estimate in writing.** Federal law requires hospitals and ASCs to provide one if you ask, and it must include all expected fees: facility, physician, anesthesia, and stent supplies.
2. **Verify in-network status for every billing party.** Confirm the gastroenterologist, the facility, the anesthesia group, and any pathologist are all in your insurance network. Ask for this in writing from each.
3. **Compare hospital outpatient versus ASC pricing.** If your case is straightforward, an ambulatory surgery center can be 30 to 50 percent cheaper for the same code. Ask your GI doctor if the ASC is appropriate for your case.
4. **Ask about stent type and price.** Metal stents cost thousands more than plastic stents. If your doctor offers a choice, ask which is clinically appropriate and what each will add to the bill.
5. **Negotiate a bundled cash-pay price if uninsured.** Hospitals often have a self-pay rate that bundles facility, physician, and anesthesia into a single discounted price.
6. **Apply for financial assistance early.** Nonprofit hospitals are required to offer charity care for patients below certain income levels. Apply before the procedure, not after the bill arrives.
7. **Plan for the second procedure.** If you are getting a stent placed, ask now what the removal procedure will cost in 6 to 12 weeks so you can budget for both.

Watch for red flags: estimates that exclude anesthesia, vague language about "professional fees," or refusal to put a price in writing. These usually mean a surprise bill is coming.

## Surprise billing risks

ERCP is a high-risk procedure for surprise medical bills because so many separate providers are involved, and one of them is almost always anesthesia. Even at an in-network hospital, the anesthesia group, the pathologist, or a consulting radiologist may be out of network. The federal No Surprises Act of 2022 protects you from balance billing in many of these situations, but you have to know how to use it.

**Most common surprise-billing sources for ERCP:**

- Anesthesiologist or CRNA from an out-of-network staffing group
- Pathologist who reads biopsy or brush cytology specimens
- Radiologist who interprets the fluoroscopy or pre-procedure MRCP
- Stent or device cost billed at a higher rate than your estimate suggested
- Emergency transfer to inpatient if a complication develops mid-procedure

**If you get a surprise bill:**

- Do not pay anything until you have an itemized bill that shows each charge, code, and provider
- For out-of-network charges at an in-network facility, file a No Surprises Act complaint at cms.gov/nosurprises
- Contact your state insurance commissioner if your state has additional balance-billing protections
- Request internal hospital review and appeal any charges that differ from your written Good Faith Estimate by more than $400

## Total recovery cost

Recovery from a routine ERCP with stent placement is usually quick. Most patients go home the same day after 1 to 2 hours in the recovery area. You will feel groggy for the rest of the day from sedation and should not drive, work, or sign legal documents for 24 hours. Mild sore throat and bloating are common for a day or two. Most people return to desk work in 1 to 2 days and full activity within a few days, unless a complication develops.

The most important post-procedure risk is post-ERCP pancreatitis, which affects 3 to 10 percent of patients. If it happens, expect a hospital admission of 2 to 5 days and significant added cost.

**Add-on costs to budget for:**

- Post-procedure clinic follow-up visit: $150 to $400
- Repeat ERCP for stent removal in 6 to 12 weeks: full procedure cost again
- Pain medication, antibiotics, or anti-nausea prescriptions: $20 to $200
- Time off work: 1 to 3 days for routine cases, 1 to 2 weeks if complications occur
- Driver and caregiver time on procedure day: required by every facility
- Lab work to recheck liver enzymes after the procedure: $50 to $300
- Hospital admission if pancreatitis develops: $5,000 to $20,000 commercial

For a straightforward case with no complications, plan for the procedure cost plus another 15 to 25 percent in follow-up visits, prescriptions, and the eventual stent removal. If you have a stent placed, the second ERCP to remove it is essentially a second full episode and should be budgeted accordingly.

## Variants of this procedure

- Bile Duct Stent Placement
- Bile Duct Stent Removal

## Frequently asked questions

### How much does ERCP cost with insurance?

With commercial insurance, the total bill typically runs $8,000 to $20,000, but your out-of-pocket share is usually $1,500 to $4,000 after deductible and coinsurance. Your annual out-of-pocket maximum caps the worst case. Verify your deductible status and confirm every provider, including the anesthesia group, is in-network before the procedure.

### Does Medicare cover ERCP?

Yes. Medicare Part B covers ERCP when it is medically necessary, which is the case for nearly all ERCPs since the procedure is not a screening test. You pay the Part B deductible ($257 in 2025) plus 20 percent coinsurance on the physician and facility fees. A Medigap or Medicare Advantage plan usually covers most or all of your share.

### How long is recovery from ERCP?

Most people go home the same day, feel groggy from sedation for 24 hours, and return to desk work within 1 to 2 days. Full recovery for a routine case is a few days. If post-ERCP pancreatitis develops (3 to 10 percent risk), expect a 2 to 5 day hospital stay and a longer recovery.

### Is ERCP outpatient or does it require a hospital stay?

ERCP is almost always an outpatient procedure done at a hospital outpatient department or ambulatory surgery center. You go home the same day. Hospital admission is only needed if you came in through the ER, have an active infection, or develop a complication like pancreatitis or bleeding.

### What's the difference between stent placement (43274) and stent removal (43275)?

Code 43274 is the original procedure where the doctor places a stent into the bile or pancreatic duct to relieve a blockage. Code 43275 is the follow-up procedure 6 to 12 weeks later to remove or exchange that stent. Both use the same scope and similar anesthesia, but removal is typically shorter and slightly less expensive.

### How do I avoid a surprise bill from anesthesia?

Before the procedure, ask the hospital scheduler which anesthesia group covers ERCPs and call your insurance to confirm that group is in-network. Get the answer in writing. The federal No Surprises Act of 2022 protects you from out-of-network anesthesia balance billing at an in-network facility, but you may need to file a complaint at cms.gov/nosurprises if billed incorrectly.

### What's the cheapest way to get an ERCP?

If you are uninsured, ask several ambulatory surgery centers for a bundled cash-pay quote. ASCs are often 30 to 50 percent cheaper than hospital outpatient departments for the same procedure. Apply for hospital financial assistance or charity care if you qualify by income. If you have insurance, the cheapest path is staying in-network for every billing party.

### Where does this cost data come from?

The Medicare figures on this page come from the CMS Medicare Physician & Other Practitioners dataset, covering services billed under codes 43274 and 43275 in the most recent year of public data. They reflect what Medicare paid the gastroenterologist; facility fees, anesthesia, and stent costs are billed separately and are not included in the $316 figure.

## Related

- [All procedure cost concepts](https://ourhealthnetwork.com/procedure-costs)
- [Find specialists who perform this procedure](https://ourhealthnetwork.com/find-doctors)
- [Insurance plans that cover this procedure](https://ourhealthnetwork.com/tools/insurance-matcher)