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See a sample rate comparisonCPT 42100 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.
Biopsy Palate Uvula
| Key Fact | Detail |
|---|---|
| Service Type | Surgery Surgical Procedures on the Digestive System |
| Common Place of Service | 11 - Office 22 - On Campus Outpatient Hospital |
| Common Modifiers | 51 - Multiple procedures GC - Service performed by resident under supervision |
| Complexity Level | Low |
| Medicare Fee Schedule | $149.97 national non-facility rate (2026) · View Medicare rates for 42100 |
| Medicaid Fee Schedule | $117.435 median of the 8 states in the free preview · View Medicaid rates for 42100 |
National average reimbursement for CPT 42100 by major payers:
$184.32
$195.30
$209.99
$186.94
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CPT 42100
5 of 25 sample ratesHigher to lower in this preview
Riverview Surgery Center At The Navy Yard Lp
$2,483.00Published rateSuburban Endoscopy Center, LLC, Suburban Endoscopy Center
Suburban Endoscopy Center LLC
$1,276.00Published ratePsg Surgery Center LLC, Surgery Center Of Amarillo
Psg Surgery Center LLC
$725.00Published rateEndoscopy Associates Of Valley Forge, LLC
Endoscopy Associates Of Valley Forge LLC
$575.00Published rateMartin Kelly
Deaconess Hospital Inc
$120.38Published rate
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See a sample payer proposalCPT 42100 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 42100 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 42100 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 42100. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 42100 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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