CPT 42200 Fee Schedule
Healthcare providers use this code to document and receive reimbursement for visits that address high-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 | • 22 - On Campus Outpatient Hospital • 21 - Inpatient Hospital |
| Common Modifiers | • None • GC - Service performed by resident under supervision • AS - PA/NP/CNS assistant at surgery |
| Complexity Level | High |
| CMS | $907.00 Physician Fee Schedule |
National average reimbursement for CPT 42200 by major payers:
$1,108.13
$1,228.70
$1,345.05
$1,523.70
| 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 42200 | ||||||
United | 42200 | $1427.00 | 1124443809 - POOLE ENDOSCOPY CENTER, LLC | 521831316 | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 42200 | $4004.00 | 1760568273 - WALLA WALLA CLINIC, INC., WALLA WALLA CLINIC AMBULATORY SURGERY CENTER | 910862542 - WALLA WALLA CLINIC, INC. | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 42200 | $1810.00 | 1487742680 - NOVAMED SURGERY CENTER OF CLEVELAND LLC, THE SURGERY CENTER OF CLEVELAND | 205493062 - (TN) NOVAMED SURGERY CENTER OF CLEVELAND LLC | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 42200 | $2384.00 | 1053575852 - EYNON SURGERY CENTER, LLC | 262791252 | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 42200 | $1471.00 | 1023071180 - SAHARA OUTPATIENT SURGERY CENTER LTD | 752509486 - (NV) SAHARA OUTPATIENT SURGERY CENTER LTD | NV | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 42200 | $5249.00 | 1205023280 - SUMMIT AMBULATORY SURGICAL CENTER, LLC | 522148280 | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 42200 | $2228.00 | 1609896539 - CEDAR HILLS AMBULATORY SURGERY CENTER LLC, CEDAR HILLS SURGERY CENTER | 680580628 - (OR) CEDAR HILLS AMBULATORY SURGERY CENTER LLC | OR | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 42200 | $1200.00 | 1275642480 - EGNM LLC, LEWES SURGERY CENTER | 510411737 - (DE) EGNM, LLC DBA LEWES SURGERY CENTER | DE | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 42200 | $1700.00 | 1295710002 - SCOTTSDALE EYE SURGERY CENTER, P.C | 860566687 - (AZ) SCOTTSDALE EYE SURGERY CENTER | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 42200 | $1500.00 | 1023123296 - ASSOCIATES SURGERY CENTERS, LLC | 510492139 - (PA) ASSOCIATES SURGERY CENTERS LLC | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 42200 | $5433.00 | 1356704027 - GLEN ECHO SURGERY CENTER, LLC | 474049838 - (MD) GLEN ECHO SURGERY CENTER LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 42200 | $6506.00 | 1104974310 - NORTHWEST SURGERY CENTER, LLP, NORTHWEST SURGERY CENTER | 205537270 - (TX) NORTHWEST SURGERY CENTER LLP | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 42200 | $5922.00 | 1528479664 - HHC SOUTHINGTON SURGERY CENTER, LLC, CHESHIRE SURGERY CENTER | 465500829 - (CT) HHC SOUTHINGTON SURGERY CENTER, LLC | CT | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 42200 | $5354.00 | 1184680225 - CAPITAL CITY SURGICAL CENTER LLC, CAPITAL CITY SURGICAL CENTER LLC | 471211202 | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 42200 | $5020.00 | 1831420694 - TITUSVILLE CENTER FOR SURGICAL EXCELLENCE LLC | 263531997 - (FL) TITUSVILLE CENTER FOR SURGICAL | FL | 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 42200 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 42200 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 42200 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 42200. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 42200 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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