What factors affect CPT 24342 fee schedules?

Factors affecting CPT 24342 fee schedules include Medicare & Medicaid rates, private insurance negotiated rates, geographic location (costs may be higher in urban areas), and provider type (hospital providers may have different rates than private practice).

How does CPT 24342 compare to other surgical procedure codes?

The CPT 24342 code is part of Surgery services used for Surgical Procedures on the Musculoskeletal System. It represents a high-complexity encounter and involves more provider time and moderate medical decision-making, including multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation compared to lower-level codes.

CPT stands for Current Procedural Terminology. CPT codes are a standardized set of medical codes developed by the American Medical Association (AMA) that healthcare providers use to describe medical, surgical, and diagnostic services to health insurance payers. These codes are essential for accurate medical billing and for communicating healthcare services to insurance companies.

How do I find the cost of a medical procedure?

The cost of a medical procedure can vary significantly based on factors such as your location, the specific healthcare provider, your insurance plan, and whether the provider is in-network or out-of-network. To get an estimate for a specific CPT code in your area, you can contact your insurance provider directly. For a quick lookup tool to search based on CPT code and specific location, you may also consider using resources like Payerprice.

What is the difference between a billed amount, allowed amount, and paid amount?

The **Billed Amount** is the total amount that a healthcare provider charges for a service before any insurance adjustments. The **Allowed Amount** is the maximum amount your insurance plan will pay for a covered service, often negotiated between the insurance company and the healthcare provider. The **Paid Amount** is the portion of the allowed amount that your insurance company actually pays to the provider after factoring in your deductible, copay, and coinsurance. You are typically responsible for the difference between the allowed amount and the paid amount, up to your out-of-pocket maximum.

How do I understand my medical bill?

To understand your medical bill, you should review the services rendered, the CPT codes used, the billed amounts, and how your insurance plan has processed the claim. Always compare your medical bill with the Explanation of Benefits (EOB) you receive from your insurance company. If you identify any discrepancies, have questions about charges, or need clarification, contact your healthcare provider's billing department or your insurance company directly.

What is an Explanation of Benefits (EOB)?

An Explanation of Benefits (EOB) is a statement sent by your health insurance company after you receive medical care. It is not a bill, but rather a detailed breakdown of what your insurance covered for the services you received. It typically includes the date of service, the service description (often with CPT codes), the amount billed by the provider, the allowed amount, how much your plan paid, and the amount you might owe (your patient responsibility). It helps you understand how your claim was processed.

What is a deductible, copay, and coinsurance?

These are common terms related to your out-of-pocket costs for healthcare: * **Deductible:** The amount you must pay out of your own pocket for healthcare services before your insurance company begins to pay. * **Copay (Copayment):** A fixed amount you pay for a covered healthcare service at the time you receive the service (e.g., $20 for a doctor's visit). * **Coinsurance:** A percentage of the cost of a covered healthcare service you pay after you've met your deductible. For example, if your coinsurance is 20%, you pay 20% of the allowed amount, and your insurance pays 80%.

CPT 24342 Fee Schedule

Last Verified: September 2026

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.

Reinsert Of Rupture Biceps Or Triceps Tndon Distal W/ Or W/, Reinsertion Of Ruptured Biceps Or Triceps Tendon Distal With Or With

Key Fact	Detail
Service Type	Surgery Surgical Procedures on the Musculoskeletal System
Common Place of Service	24 - Ambulatory Surgical Center 22 - On Campus Outpatient Hospital
Common Modifiers	None RT - Right side of body LT - Left side of body
Complexity Level	High
Medicare Fee Schedule	View Medicare rates for 24342
Medicaid Fee Schedule	View Medicaid rates for 24342

National average reimbursement for CPT 24342 by major payers:

$1,020.61

$1,052.67

$1,110.94

$1,277.84

Compare published rates across providers.

Choose a payer to see a sample of rates for CPT 24342.

CPT 24342

5 of 25 sample ratesHigher to lower in this preview

Methodist Healthcare System Of San Antonio, Ltd., L.L.P., Methodist Hospital Hill Country
TXGeneral Acute Care HospitalNPI 1376256354Tax ID 74-2730328
$8,440.00Published rate
Bristol Ambulatory Surgery Center, LLC
TNAmbulatory Surgical Clinic/CenterNPI 1790344182Tax ID 83-4345983
$5,020.00Published rate
Advanced Ambulatory Surgery Center Lp
Advanced Ambulatory Surgery
CAAmbulatory Surgical Clinic/CenterNPI 1881690949Tax ID 73-1675692
$2,850.00Published rate
Barnet Dulaney Perkins Eye Center, PC, Bdpec Asc Sedona
Barnet Dulaney Perkins Eye Center PLLC
AZAmbulatory Surgical Clinic/CenterNPI 1093088304Tax ID 56-2589722
$1,550.00Published rate
Southwest Endoscopy And Surgery Center
TXAmbulatory Surgical Clinic/CenterNPI 1649494170Tax ID 20-3136303
$884.00Published rate

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Summit Women's CareDenver, Colorado

September 2, 2026

Contracting Manager
UnitedHealthcare
Commercial PPO

Re: Request for fee schedule renegotiation

We request a formal review of our Commercial PPO fee schedule. The comparison below summarizes our current rate alongside published rates for comparable Denver-area practices.

Market evidence · CPT 59485

Current rate: $152.40
Market median: $147.00
Market position: 61st percentile

The comparison includes 1,284 published rates from 96 provider groups, scoped to OB/GYN providers in a professional, office-based setting.

We would welcome a discussion of our fee schedule and the supporting July 2026 market analysis. Please let us know a suitable time to review the comparison together.

Sincerely,
Summit Women's Care

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CPT 24342 vs. Other Surgical Procedures on the Musculoskeletal System Codes

The CPT 24342 code is part of the Surgery services used for Surgical Procedures on the Musculoskeletal 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 24342 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
24340-CPT	Moderate	Tenodesis Rupture Biceps At Elbow
24341-CPT	High	Rpr Tdn Musc Upr A E Each, Repair Tendon Or Muscle Upper Arm Or Elbow Each Tendon Or Muscle Primary Or Secondary Excludes Rotator Cuff
24342-CPT	High	Reinsert Of Rupture Biceps Or Triceps Tndon Distal W/ Or W/, Reinsertion Of Ruptured Biceps Or Triceps Tendon Distal With Or With
24343-CPT	Moderate	Repair Lateral Collateral Ligament, Elbow, With Local Tissue

What is a fee schedule?

A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 24342. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.

Understanding the 24342 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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CPT 24342 Fee Schedule

Compare published rates across providers.

Methodist Healthcare System Of San Antonio, Ltd., L.L.P., Methodist Hospital Hill Country

Bristol Ambulatory Surgery Center, LLC

Advanced Ambulatory Surgery Center Lp

Barnet Dulaney Perkins Eye Center, PC, Bdpec Asc Sedona

Southwest Endoscopy And Surgery Center