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See a sample rate comparisonCPT 42000 Fee Schedule
Last Verified: October 2026
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.
Drain Abscess On Roof Of Mouth, Surgery To Drain Pus Or Infected Fluid From An Abscess (Pocket Of Infection) In The Back Of The Roof Of The Mouth.
| Key Fact | Detail |
|---|---|
| Service Type | Surgery Surgical Procedures on the Digestive System |
| Common Place of Service | 23 - Emergency Room 11 - Office |
| Common Modifiers | AG - Primary physician GC - Service performed by resident under supervision |
| Complexity Level | Low |
| Medicare Fee Schedule | $159.99 national non-facility rate (2026) · View Medicare rates for 42000 |
| Medicaid Fee Schedule | $126.995 median of the 8 states in the free preview · View Medicaid rates for 42000 |
National average reimbursement for CPT 42000 by major payers:
$184.99
$208.21
$221.02
$257.94
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CPT 42000
5 of 25 sample ratesHigher to lower in this preview
Newport Surgical Partners LLC, Newport Plaza Surgical Center
$843.00Published rateThe University Of Texas At Austin, Ut Health Austin Ambulatory Surgery Center
$250.00Published rateKlamath Surgery Center LLC, Klamath Surgeons LLC
Klamath Surgery Center LLC
$155.00Published rateCorpus Christi Endoscopy Center LLP, Corpus Christi Endoscopy Center
Corpus Christi Endoscopy Center LLP
$111.00Published rateDoctors Surgery Center Of Texarkana, Doctor'S Surgery Center
Doctors Surgery Center Of Texarkana
$69.00Published rate
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See a sample payer proposalCPT 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 Catheter, Placement Of Needles Catheters Or Other Device(S) Into The Head Andor Neck Region (Percutaneous Transoral Or Transnasal) For Subsequent Interstitial Radioelement Application |
| 41100-CPT | Moderate | Biopsy Tongue; Anterior Two-Thirds |
| 42000-CPT | Low | Drain Abscess On Roof Of Mouth, Surgery To Drain Pus Or Infected Fluid From An Abscess (Pocket Of Infection) In The Back Of The Roof Of The Mouth. |
| 42100-CPT | Low | Biopsy 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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