CPT 42140 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 | • 24 - Ambulatory Surgical Center • 22 - On Campus Outpatient Hospital |
| Common Modifiers | • None • 51 - Multiple procedures • 52 - Reduced Services |
| Complexity Level | Moderate |
National average reimbursement for CPT 42140 by major payers:

$338.27

$349.15

$394.98

$472.48
| 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 42140 | ||||||
United | 42140 | $585.00 | 1023115078 - MAIN LINE PA ENDOSCOPY ASC LP, MAIN LINE ENDOSCOPY CENTER MALVERN | 205301211 | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 42140 | $496.00 | 1396277208 - ELITE SURGERY CENTER, LLC | 820836081 - (CA) ELITE SURGERY CENTER LLC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 42140 | $1258.00 | 1336142413 - TEXAN AMBULATORY SURGERY CENTER, LP | 331058382 | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 42140 | $639.00 | 1972850808 - LAKE RIDGE AMBULATORY SURGERY CENTER, LLC, LAKE RIDGE SURGERY CENTER | 455347932 - (VA) LAKE RIDGE AMBULATORY SURGERY CENTER LLC | VA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 42140 | $645.00 | 1124587548 - GATEWAY SURGICAL CENTER, LLC | 830521568 - (TX) GATEWAY SURGICAL CENTER LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 42140 | $2382.00 | 1508169921 - SAINT LUKES-GI DIAGNOSTICS LLC | 274142549 - (MO) SAINT LUKESGI DIAGNOSTICS LLC | MO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 42140 | $643.00 | 1164833687 - INTERVENTIONAL PAIN MANAGEMENT LLC | 452192531 - (IN) INTERVENTIONAL PAIN MANAGEMENT LLC | IN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 42140 | $789.00 | 1992702443 - THE EASTSIDE ENDOSCOPY CENTER LLC | 911665997 - (WA) THE EASTSIDE ENDOSCOPY CENTER LLC | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 42140 | $691.00 | 1891071072 - ST. CHARLES SURGERY CENTER | 275109874 - (MO) ST. CHARLES SURGERY CENTER, LLC | MO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 42140 | $496.00 | 1821047499 - RIVERSIDE SURGERY CENTER, INC. | 680400319 - (CA) RIVERSIDE SURGERY CENTER INC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 42140 | $775.00 | 1073987053 - SERENITY SURGICAL, LLC | 471546645 - (IN) SERENITY SURGICAL, LLC | IN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 42140 | $496.00 | 1780604694 - CLEARVIEW SURGERY CENTER INC | 202828714 | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 42140 | $840.00 | 1568918746 - ORTHOPEDIC SURGERY CENTER OF PALM BEACH COUNTY, LLC | 812594417 - (FL) ORTHOPEDIC SURGERY CENTER OF PALM BEACH COUNTY LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 42140 | $2259.00 | 1285202077 - SURGCENTER OF PINE RIDGE LLC | 853561528 - (FL) SURGCENTER OF PINE RIDGE LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 42140 | $591.00 | 1033102140 - SSC HOLDINGS LLC, SEDONA SURGERY CENTER | 470887316 - (CA) SSC HOLDINGS LLC | CA | 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 42140 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 42140 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 42140 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.
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 42140. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 42140 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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