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See a sample rate comparisonCPT 42280 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.
Maxillary Impression For Palatal Prosthe
| Key Fact | Detail |
|---|---|
| Service Type | Surgery Surgical Procedures on the Digestive System |
| Common Place of Service | 11 - Office 21 - Inpatient Hospital 22 - On Campus Outpatient Hospital |
| Common Modifiers | 58 - Staged or related procedure during postoperative period 51 - Multiple procedures |
| Complexity Level | Moderate |
| Medicare Fee Schedule | $185.04 national non-facility rate (2026) · View Medicare rates for 42280 |
| Medicaid Fee Schedule | $144.535 median of the 8 states in the free preview · View Medicaid rates for 42280 |
National average reimbursement for CPT 42280 by major payers:
$211.71
$223.43
$231.31
$188.10
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CPT 42280
5 of 25 sample ratesHigher to lower in this preview
Indianapolis Endoscopy Center LLP
$3,922.00Published rateSalmon Surgery Center LLC
$574.00Published rateTampa Bay Surgery Center Associates,Ltd
Tampa Bay Surgery Center Assoc
$300.00Published rateCascade Eye & Skin Centers PC, Cascade Laser & Surgery Center
Cascade Eye And Skin Centers, P.C.
$118.00Published rateGi Asc LLC
$52.00Published rate
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Payer Contract Negotiation
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See a sample payer proposalCPT 42280 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 42280 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 42280 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 |
|---|---|---|
| 42280-CPT | Moderate | Maxillary Impression For Palatal Prosthe |
| 42281-CPT | Moderate | Insert Prosthesis Palate Pin Type |
| 42299-CPT | High | Surgery On Uvula Or Palate, Surgery Performed On The Uvula Or The Roof Of The Mouth (Palate). |
| 42400-CPT | Low | Saliva Gland Biopsy, A Procedure To Remove A Sample Of Tissue From A Saliva Gland For Testing (Biopsy). The Sample May Be Taken In A Surgery Or With A Needle. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 42280. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 42280 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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