CPT 42510 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 | • 22 - On Campus Outpatient Hospital • 21 - Inpatient Hospital |
| Common Modifiers | • None • AS - PA/NP/CNS assistant at surgery • 52 - Reduced Services |
| Complexity Level | Moderate |
| CMS | $593.56 Physician Fee Schedule |
National average reimbursement for CPT 42510 by major payers:
$792.48
$833.39
$858.96
$1,032.06
| 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 42510 | ||||||
United | 42510 | $1283.00 | 1093764045 - GASTROENTEROLOGY OF INDIANAPOLIS PC, DIGESTIVE HEALTH CENTER | 351641181 - (IN) GASTROENTEROLOGY OF INDIANAPOLIS, P . C. | IN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 42510 | $15719.00 | 1881678662 - SURGERY AFFILIATE OF EL PASO, LLC, FOUNDATION SURGERY AFFILIATE OF EL PASO, LLC | 742797719 - (TX) SURGERY AFFILIATE OF EL PASO LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 42510 | $2782.00 | 1295848752 - ESSEX SURGICAL ARTS SURGERY CENTER, LLC, MOBILE VASCULAR PHYSICIANS | 202242123 - (NJ) ESSEX SURGICAL ARTS SURGERY | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 42510 | $2108.00 | 1730252487 - J C PITTS ENTERPRISES INC, ONTARIO SURGERY CENTER | 930983555 - (OR) J C PITTS ENTERPRISES INC | OR | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 42510 | $8825.00 | 1730146861 - CONROE SURGERY CENTER 2, LLC | 760697645 - (TX) CONROE SURGERY CENTER 2 LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 42510 | $2618.00 | 1992702443 - THE EASTSIDE ENDOSCOPY CENTER LLC | 911665997 - (WA) THE EASTSIDE ENDOSCOPY CENTER LLC | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 42510 | $1550.00 | 1255604534 - BARNET DULANEY PERKINS EYE CENTER, PC, BDPEC TUCSON | 562589722 - BARNET DULANEY PERKINS EYE CENTER PLLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 42510 | $2108.00 | 1811001548 - AMBULATORY SURGERY CENTER OF OPELOUSAS | 721502278 - (LA) AMBULATORY SURGERY CENTER OF O | LA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 42510 | $5354.00 | 1043803877 - PALM BEACH INTERNATIONAL SURGERY CENTER LLC, PALM BEACH INTERNATIONAL SURGERY CENTER AT THE PALEY INSTITUTE | 384092545 - (FL) PALM BEACH INTERNATIONAL SURGERY CENTER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 42510 | $600.00 | 1366498347 - MINIMALLY INVASIVE SURGERY CENTER, P.A. | 223577926 | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 42510 | $3155.00 | 1619245230 - AMBULATORY SURGICAL PAVILION AT ROBERT WOOD JOHNSON LLC | 800768614 - (NJ) AMBULATORY SURGICAL PAVILION AT ROBERT WOOD JOHNSON LLC | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 42510 | $2800.00 | 1730876210 - MEDICAL CITY SURGERY CENTER NORTH TEXAS, LLC | 923326615 | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 42510 | $4014.00 | 1275158495 - BCC CHANDLER LLC | 851284830 - (AZ) BCC CHANDLER LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 42510 | $5433.00 | 1205023280 - SUMMIT AMBULATORY SURGICAL CENTER, LLC | 522148280 | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 42510 | $5433.00 | 1144954165 - ADVANCED SURGICAL CARE OF LUTZ, LLC, ADVANCED SURGICAL CARE OF NEW TAMPA | 871390521 - (FL) ADVANCED SURGICAL CARE OF LUTZ LLC | 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 42510 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 42510 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 42510 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 |
|---|---|---|
| 42335-CPT | Moderate | Sialolithotomy;Subman/Submax,Complicat,I |
| 42425-CPT | High | Exc Parotid Total Sacrifice Nerve |
| 42500-CPT | Moderate | Sialodochoplasty Primary/Simple |
| 42510-CPT | Moderate | Creation Of New Drainage Tracts Of Major Saliva Gland Ducts On Both Sides Of Mouth With Tying Of Saliva Gland Ducts Below Both Sides Of Jaw |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 42510. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 42510 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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