Rate Benchmarking
Compare your rates with similar providers.
Select a published rate, define comparable providers, and see where that rate falls in your market.
See a sample rate comparisonCPT 42330 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.
Sialolithotomy Submandibular, Sialolithotomy Submandibular (Submaxillary) Sublingual Or Parotid Uncomplicated Intraoral Sialolithotomy Submandibular (Submaxillary) Sublingual Or
| 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 | LT - Left side of body RT - Right side of body |
| Complexity Level | Moderate |
| Medicare Fee Schedule | $237.81 national non-facility rate (2026) · View Medicare rates for 42330 |
| Medicaid Fee Schedule | $185.265 median of the 8 states in the free preview · View Medicaid rates for 42330 |
National average reimbursement for CPT 42330 by major payers:
$302.85
$304.68
$326.39
$280.15
Compare published rates across providers.
Choose a payer to see a sample of rates for CPT 42330.
CPT 42330
5 of 25 sample ratesHigher to lower in this preview
Bayonet Point Surgery Center Ltd
$5,532.00Published rateCharlotte Endoscopic Surgery Center LLC, Charlotte Surgery Center
Charlotte Endoscopic Surgery Center, LLC
$1,233.00Published rateDoctors Hospital Surgery Center, L.P.
Doctors Hospital Surgery Center Lp
$955.00Published rateNorth Valley Endoscopy Center LLC
$605.00Published rateJoyce Bussard
Deaconess Hospital Inc
$187.36Published rate
Get a free rate benchmark for your specialty.
Choose your state and specialty to build a report from payer-published rates.
Use market rates to prepare your payer proposal.
Payer Contract Negotiation
Draft a fee schedule renegotiation letter.
Use your fee schedule and market benchmarks to set target rates and draft a letter for your payer.
See a sample payer proposalCPT 42330 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 42330 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 42330 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 |
|---|---|---|
| 42330-CPT | Moderate | Sialolithotomy Submandibular, Sialolithotomy Submandibular (Submaxillary) Sublingual Or Parotid Uncomplicated Intraoral Sialolithotomy Submandibular (Submaxillary) Sublingual Or |
| 42335-CPT | Moderate | Sialolithotomy Submandibular, Sialolithotomy Submandibular (Submaxillary) Complicatedintraoral Sialolithotomy Submandibular (Submaxillary) Complicated |
| 42340-CPT | Moderate | Sialolithotomy Parotid Extra, Sialolithotomy Parotid Extraoral Or Complicated Intraoral Sialolithotomy Parotid Extraoral Or Complicated Intraoral |
| 42440-CPT | Moderate | Exc Submandibular Gland |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 42330. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 42330 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.
FREE SAMPLE MARKET COMPARISON
Let's review your payer contracts side-by-side with the market.
Bring your top codes (like CPT 42330) and we'll show you how you compare in 15 minutes or less.