CPT 42000 Fee Schedule
Healthcare providers use this code to document and receive reimbursement for visits that address moderate-level medical decision-making, often including multiple diagnoses or prescription management.
| Key Fact | Detail |
|---|---|
| Service Type | • Surgery • Surgical Procedures on the Digestive System |
| Common Place of Service | • 23 - Emergency Room • 11 - Office |
| Common Modifiers | • None • AG - Primary physician • GC - Service performed by resident under supervision |
| Complexity Level | Low |
National average reimbursement for CPT 42000 by major payers:
$184.99
$208.21
$221.02
$266.63
| 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 42000 | ||||||
United | 42000 | $281.00 | 1669772893 - ADVANCED EYE SURGERY CENTER, L.L.C. | 273717607 - (KS) ADVANCED EYE SURGERY CENTER LLC | KS | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 42000 | $174.00 | 1285690073 - BIRMINGHAM OUTPATIENT SURGERY CENTER LTD, OUTPATIENT CARECENTER | 630984076 - (AL) BIRMINGHAM OUTPATIENT SURGERY CENTER LTD | AL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 42000 | $736.00 | 1033351119 - SSM ST CLARE SURGICAL CENTER LLC, SSM ST CLARE SURGICAL CENTER | 261439695 - (MO) SSM ST CLARE SURGICAL CENTER LLC | MO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 42000 | $110.00 | 1992784821 - EYE SURGERY CENTER OF CHESTER COUNTY, LLC, VISION ONE LASER & SURGERY CENTER | 232922796 - (PA) EYE SURGERY CENTER OF CHESTER COUNTY, LLC | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 42000 | $215.00 | 1790066876 - CAROMONT HEALTH SERVICES, INC., CAROMONT ENDOSCOPY CENTER | 561455630 - (NC) CAROMONT HEALTH SERVICES INC | NC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 42000 | $225.00 | 1275158495 - BCC CHANDLER LLC | 851284830 - (AZ) BCC CHANDLER LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 42000 | $160.00 | 1578073631 - IREDELL PHYSICIAN NETWORK LLC, IREDELL AMBULATORY SURGERY CENTER | 263853529 | NC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 42000 | $130.00 | 1437801388 - FRESENIUS ACCESS CARE PHYSICIANS OF MADISON ASC LLC | 863588248 - (WI) FRESENIUS ACCESS CARE PHYSICIANS OF MADISON ASC LLC | WI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 42000 | $301.00 | 1548984263 - ALLINA HEALTH SURGERY CENTER | 883732480 | MN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 42000 | $328.00 | 1952312399 - ZITELLI & BRODLAND PC, ZITELLI & BRODLAND ASF SOUTH | 251549973 - JOHN A. ZITELLI, MD, PC | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 42000 | $171.00 | 1265679674 - GEORGIA UROLOGY FAYETTE ASC | 550846177 | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 42000 | $265.00 | 1790172922 - YUMA VALLEY AMBULATORY PAIN SERVICES INC | 471779727 - (AZ) YUMA VALLEY AMBULATORY PAIN SERVICES INC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 42000 | $410.00 | 1760445928 - ARIZONA ENDOSCOPY CENTER, LLC | 860908400 - (AZ) ARIZONA ENDOSCOPY CENTER LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 42000 | $168.00 | 1861418378 - MAPLEWOOD AMBULATORY SURGERY CENTER, INC. | 752730666 - (TX) MAPLEWOOD AMBULATORY SURGERY CENTER INC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 42000 | $182.00 | 1184627978 - NOVAMED SURGERY CENTER OF ORLANDO LLC, DOWNTOWN SURGERY CENTER | 522441418 - (FL) NOVAMED SURGERY CENTER OF ORLANDO LLC | FL | 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 42000 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 42000 code is part of the Surgery services used for Surgical Procedures on the Digestive 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 42000 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 |
|---|---|---|
| 41019-CPT | Moderate | Placement Of Needles Catheters Or Other Device(S) Into The Head And/Or Neck Region (Percutaneous Transoral Or Transnasal) For Subsequent Interstitial Radioelement Application |
| 41100-CPT | Moderate | Biopsy Tongue; Anterior Two-Thirds |
| 41800-CPT | Moderate | Drain Lesion Dentoalveolar |
| 42000-CPT | Low | Drain Abscess Palate Uvula |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 42000. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 42000 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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