CPT 42182 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 | • 21 - Inpatient Hospital • 20 - Urgent Care Facility • 22 - On Campus Outpatient Hospital |
| Common Modifiers | • None • 51 - Multiple procedures • GC - Service performed by resident under supervision |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 42182 |
National average reimbursement for CPT 42182 by major payers:
$409.79
$430.85
$451.85
$540.70
| 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 42182 | ||||||
United | 42182 | $2762.00 | 1912434697 - SUMMIT AMBULATORY SURGICAL CENTER, LLC | 522148280 | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 42182 | $3150.00 | 1386882587 - BAYLOR SURGICARE AT GRANBURY LLC, BAYLOR SCOTT & WHITE SURGICARE-GRANBURY | 263896477 | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 42182 | $610.00 | 1710047188 - ARROWHEAD ENDOSCOPY AND PAIN MANAGEMENT CENTER LLC, ARROWHEAD ENDOSCOPY CENTER. | 205706445 - (AZ) ARROWHEAD ENDOSCOPY AND PAIN MAN | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 42182 | $3142.00 | 1437116274 - SILVER SPRINGS SURGERY CENTER LLC | 431804124 - (MO) SILVER SPRINGS SURGERY CENTER LLC | MO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 42182 | $1829.00 | 1730487083 - INTERVENTIONAL SPINE CENTER, LLC | 263161503 - (CA) INTERVENTIONAL SPINE CENTER LLC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 42182 | $1142.00 | 1225228547 - GULF COAST SURGICAL CENTER LLC | 203321032 - (LA) GULF COAST SURGICAL CENTER, LLC | LA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 42182 | $1309.00 | 1548710775 - LINCOLN DIGESTIVE HEALTH CENTER LLC | 371833798 - (NE) LINCOLN DIGESTIVE HEALTH CENTER LLC | NE | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 42182 | $1272.00 | 1144607862 - DEKALB SURGICAL SERVICES, LLC | 471088369 - (IL) DEKALB SURGICAL SERVICES LLC | IL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 42182 | $689.00 | 1134499684 - CHILDRENS SURGERY CENTER OF MALVERN, LLC | 452608984 - (PA) CHILDRENS SURGERY CENTER OF MALVERN LLC | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 42182 | $2547.00 | 1881001758 - ASUCH SURGERY CENTER | 455067682 | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 42182 | $2206.00 | 1720085277 - ROSWELL SURGERY CENTER LLC, ROSWELL SURGERY CENTER | 582577112 - (GA) ROSWELL SURGERY CENTER LLC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 42182 | $261.19 | 1609833169 - RANDALL KRAWCHECK | 350593390 - DEACONESS HOSPITAL INC | VA | Surgical Critical Care Physician (2086S0102X) |
United | 42182 | $568.46 | 1942705694 - KHALIL BEYDOUN | 350593390 - DEACONESS HOSPITAL INC | MI | Anesthesiology Physician (207L00000X) |
United | 42182 | $1750.00 | 1922660109 - BANNER SURGERY CENTER | 842157389 - (AZ) BANNER SURGERY CENTER | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 42182 | $850.00 | 1467788729 - WATERFORD SURGICAL CENTER, LLC | 271110813 - (MI) WATERFORD SURGICAL CENTER | MI | 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 42182 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 42182 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 42182 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 |
|---|---|---|
| 42180-CPT | Moderate | Repair Laceration Palate To 2 Cm |
| 42182-CPT | Moderate | Repair Lac Palate > 2cmor Complex |
| 42200-CPT | High | Palatoplasty For Cleft Palate Soft A/O H |
| 42210-CPT | High | Palatoplasty For Cleft Palate, With Closure Of Alveolar Ridge; With Bone Graft To Alveolar Ridge (Includes Obtaining Graft) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 42182. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 42182 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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