CPT 25442 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 Musculoskeletal System |
| Common Place of Service | • 22 - On Campus Outpatient Hospital • 24 - Ambulatory Surgical Center |
| Common Modifiers | • None • RT - Right side of body • LT - Left side of body |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 25442 |
National average reimbursement for CPT 25442 by major payers:
$1,094.78
$1,082.84
$1,091.82
$1,368.26
| 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 25442 | ||||||
United | 25442 | $2000.00 | 1093295545 - SURGERY CENTER 121 LLC | 831195079 - (TX) SURGERY CENTER 121 LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25442 | $9510.00 | 1205945243 - FLORIDA ORTHOPAEDIC INSTITUTE SURGERY CENTER LLC | 593646134 - (FL) FLORIDA ORTHOPAEDIC INSTITUTE SURGERY CENTER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25442 | $4376.00 | 1184749673 - WAYNE SURGICAL CENTER LLC | 223535325 - (NJ) WAYNE SURGICAL CENTER, LLC | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25442 | $1375.00 | 1356814958 - CLEVELAND CHILDRENS SURGERY CENTER LLC | 301128634 - (OH) CLEVELAND CHILDRENS SURGERY CENTER LLC | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25442 | $9650.00 | 1376779561 - SURGICARE OF MIRAMAR LLC | 208552194 - (FL) SURGICARE OF MIRAMAR LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25442 | $5495.00 | 1609870336 - DESOTO SURGICARE PARTNERS, LTD, NORTH TEXAS SURGERY CENTER | 752592508 - (TX) DESOTO SURGICARE PARTNERS LTD | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25442 | $6414.00 | 1164601696 - SALVATORE DIMERCURIO MD PA | 521833726 - (MD) SALVATORE DIMERCURIO, M.D., P.A. | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25442 | $8116.00 | 1417278011 - WILSHIRE SURGERY CENTER, LLC | 270616665 - (OR) WILSHIRE SURGERY CENTER | OR | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25442 | $5164.00 | 1538769302 - SPINE SOLUTIONS OF GREEN BAY LLC | 853678180 - (WI) SPINE SOLUTIONS OF GREEN BAY LLC | WI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25442 | $10873.00 | 1306472063 - THE EMORY CLINIC INC, EMORY ENDOSCOPY CENTER AT DECATUR | 582030692 - EMORY UNIVERSITY | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25442 | $6221.00 | 1821167479 - EVERGREEN EYE CENTER, PLLC, EVERGREEN EYE SURGERY CENTER | 911628032 - (WA) EVERGREEN EYE CENTER, INC. P.S. | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25442 | $9728.00 | 1295256295 - SOUTHWEST ATLANTA VASCULAR CARE, LLC | 820825564 - (GA) SOUTHWEST ATLANTA VASCULAR CARE LLC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25442 | $6244.00 | 1770731853 - SHAWNEE MISSION PRAIRIE STAR SURGERY CENTER LLC, ADVENTHEALTH SURGERY CENTER LENEXA | 364634843 - (KS) SHAWNEE MISSION PRAIRIE STAR SURGERY CENTER LLC | KS | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25442 | $3624.00 | 1730227992 - MEMORIAL AMBULATORY SURGERY CENTER, LLC | 210634562 - (NJ) VIRTUA-MEMORIAL HOSPITAL BURLINGTON COUNTY INC | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25442 | $6262.00 | 1811947062 - WACO GASTROENTEROLOGY ENDOSCOPY CENTER LLC, WACO GASTROENTEROLOGY ENDOSCOPY CENTER | 43636953 - (TX) WACO GASTROENTEROLOGY ENDOSCOPY CENTER LLC | TX | 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 25442 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 25442 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 25442 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 |
|---|---|---|
| 25394-CPT | High | Osteoplasty, Carpal Bone, Shortening |
| 25430-CPT | Moderate | Insertion Of Vascular Pedicle Into Carpal Bone (Eg, Harii Procedure) |
| 25431-CPT | High | Repair Of Nonunion Of Carpal Bone (Excluding Carpal Scaphoid (Navicular)) (Includes Obtaining Graft And Necessary Fixation), Each Bone |
| 25442-CPT | High | Arthroplasty W Prosthetic Replace;Distal |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 25442. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 25442 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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