CPT 19342 Fee Schedule
Healthcare providers use this code to document and receive reimbursement for visits that address high-level medical decision-making, often including multiple diagnoses or prescription management.
| Key Fact | Detail |
|---|---|
| Service Type | • Surgery • Surgical Procedures on the Integumentary System |
| Common Place of Service | • 22 - On Campus Outpatient Hospital • 24 - Ambulatory Surgical Center |
| Common Modifiers | • None • 50 - Bilateral Procedure • RT - Right side of body |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 19342 |
National average reimbursement for CPT 19342 by major payers:
$1,098.36
$1,179.58
$1,147.29
$1,378.46
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
Select a payer to view fee schedule data Choose a payer from the options above to see rates for CPT 19342 | ||||||
United | 19342 | $1429.00 | 1588879266 - BAYSIDE ENDOSCOPY CENTER LLC, EAST GREENWICH ENDOSCOPY CENTER | 200207545 - (RI) BAYSIDE ENDOSCOPY CENTER LLC | RI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 19342 | $1072.50 | 1699702050 - VIRGINIA MASON MEDICAL CENTER, VIRGINIA MASON BELLEVUE ASC | 910565539 - (WA) VIRGINIA MASON MEDICAL CENTER | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 19342 | $4932.00 | 1205082948 - BECKER PLASTIC SURGERY CENTER | 208056374 - (ND) BECKER PLASTIC SURGERY CENTER, LLC | ND | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 19342 | $6300.00 | 1760440515 - SIERRA ENDOSCOPY CENTER, LLC | 680482297 - (CA) SIERRA ENDOSCOPY CENTER LLC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 19342 | $1472.00 | 1851516728 - PHOENIX ENDOSCOPY LLC | 710940187 - (AZ) PHOENIX ENDOSCOPY LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 19342 | $8090.00 | 1568884104 - EMORY AMBULATORY SURGERY CENTER AT DUNWOODY, LLC | 464115055 - (GA) EMORY AMBULATORY SURGERY CENTER AT DUNWOODY LLC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 19342 | $5048.00 | 1407836315 - SPINE CARE DELAWARE, LLC | 510393046 - (DE) SPINE CARE DELAWARE LLC | DE | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 19342 | $3858.00 | 1497746747 - PHYSICIANS' SURGERY CENTER OF VICTORVILLE LLC | 260057464 - (CA) PHYSICIANS SURGERY CENTER OF VICTORVILLE, LLC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 19342 | $7888.00 | 1689664906 - PEDIATRIC SURGERY CENTERS, LLC | 201711553 | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 19342 | $1464.00 | 1376789248 - PIONEER AMBULATORY SURGERY CENTER, LLC | 262749514 - (NC) PIONEER AMBULATORY SURGERY CENTER LLC | NC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 19342 | $1993.00 | 1194163576 - CEC SURGICAL SERVICES, LLC | 461929574 - (MD) CEC SURGICAL SERVICES LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 19342 | $6365.00 | 1750499950 - MEDPLEX OUTPATIENT SURGERY CENTER LTD, MEDPLEX OUTPATIENT SURGERY CENTER | 760353620 - (AL) MEDPLEX OUTPATIENT SURGERY CENTER LTD | AL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 19342 | $5250.00 | 1366643751 - SPECIALTY SURGICAL CENTER OF THOUSAND OAKS, L.P. | 205991988 - (CA) SPECIALTY SURGICAL CENTER OF THOUSAND OAKS, LP | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 19342 | $5041.00 | 1295790327 - ENDOSCOPY OF PLANO, LP, GASTROINTESTINAL ENDOSCOPY CENTER OF PLANO | 201477775 - (TX) ENDOSCOPY OF PLANO LP | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 19342 | $2325.00 | 1588323513 - RIVER POINT SURGERY CENTER, LLC | 863521069 - RIVER POINT SURGERY CENTER | CO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
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CPT 19342 vs. Other Surgical Procedures on the Integumentary System Codes
The CPT 19342 code is part of the Surgery services used for Surgical Procedures on the Integumentary System. It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.
The CPT 19342 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.
| Code | Complexity | Description |
|---|---|---|
| 19301-CPT | Moderate | Mastectomy, Partial (E.G. Lumpectomy, Tylectomy, Quandrantectomy, Segmentectomy) |
| 19340-CPT | Moderate | Insertion Of Breast Implant On Same Day Of Mastectomy (Ie Immediate) (Desc Rvsd 1/1/21) |
| 19342-CPT | High | Insertion Or Replacement Of Breast Implant On Separate Day From Mastectomy (Desc Rvsd 1/1/21) |
| 19350-CPT | High | Reconstruct Nipple/Areolar Unil |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 19342. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 19342 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.
Factors that affect fee schedules
Medicare & Medicaid Rates
Government-set reimbursement amounts
Private Insurance Rates
Negotiated rates between providers and insurance companies
Geographic Location
Costs may be higher in urban areas.
Provider Type
Hospital providers may have different rates than private practice.
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