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 |
| Medicare Fee Schedule | View Medicare rates for 42000 |
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 | $121.00 | 1760773949 - PIEDMONT OUTPATIENT SURGERY CENTER, LLC | 273982668 - (NC) PIEDMONT OUTPATIENT SURGERY CENTER LLC | NC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 42000 | $248.00 | 1033282173 - TEMECULA VALLEY DAY SURGERY & PAIN THERAPY CENTER, INC. | 330469645 - (CA) TEMECULA VALLEY DAY SURGERY PAIN THERAPY CENTER INC | CA | 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 | $77.00 | 1306958103 - NEI AMBULATORY SURGERY CENTER INC PC | 232429169 - (PA) NEI AMBULATORY SURGERY CENTER INC PC | PA | 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 | $150.00 | 1144827114 - GULFSTREAM SURGICAL FORT WORTH LLC | 851495125 - (TX) GULFSTREAM SURGICAL FORT WORTH | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 42000 | $111.00 | 1831238773 - CORPUS CHRISTI ENDOSCOPY CENTER LLP, CORPUS CHRISTI ENDOSCOPY CENTER | 202595593 - (TX) CORPUS CHRISTI ENDOSCOPY CENTER LLP | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 42000 | $104.00 | 1578567954 - E. RONALD SALVITTI, M.D., INC., SOUTHWESTERN PA EYE SURGERY CENTER | 251787703 - (PA) E. RONALD SALVITTI, M.D., INC. | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 42000 | $272.73 | 1982810990 - JOSEPH JENKINS | 350593390 - DEACONESS HOSPITAL INC | IN | Emergency Medicine Physician (207P00000X) |
United | 42000 | $69.00 | 1275574154 - DOCTORS SURGERY CENTER OF TEXARKANA, DOCTOR'S SURGERY CENTER | 710796220 - (AR) DOCTORS SURGERY CENTER OF TEXARKANA | AR | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 42000 | $125.30 | 1245800671 - DONNY LE | 350593390 - DEACONESS HOSPITAL INC | PA | Certified Registered Nurse Anesthetist (367500000X) |
United | 42000 | $586.00 | 1346270329 - MARY IMMACULATE AMBULATORY SURGERY CENTER LLC | 200485202 - (VA) MARY IMMACULATE AMBULATORY SURGERY CENTER LLC | VA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 42000 | $566.00 | 1245711803 - SURGCENTER CLEARWATER, LLC, SURGCENTER DUNEDIN | 823682684 - (FL) SURGCENTER CLEARWATER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 42000 | $250.00 | 1538113238 - ADVANCED LASER & SURGICENTER OF ARIZONA, PC | 721546625 | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 42000 | $111.00 | 1023399318 - CANDESCENT EYE SURGICENTER LLC | 452898656 | RI | 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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