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See a sample rate comparisonCPT 42550 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.
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| Key Fact | Detail |
|---|---|
| Service Type | Surgery Surgical Procedures on the Digestive System |
| Common Place of Service | 22 - On Campus Outpatient Hospital 11 - Office |
| Common Modifiers | LT - Left side of body RT - Right side of body |
| Complexity Level | Low |
| Medicare Fee Schedule | $146.96 national non-facility rate (2026) · View Medicare rates for 42550 |
| Medicaid Fee Schedule | $118.48 median of the 8 states in the free preview · View Medicaid rates for 42550 |
National average reimbursement for CPT 42550 by major payers:
$182.66
$211.55
$211.24
$121.04
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CPT 42550
5 of 25 sample ratesHigher to lower in this preview
East Mequon Surgery Center LLC
$1,665.00Published rate90210 Surgery Medical Center, LLC, 90210 Surgery Medical Center At Linden
90210 Surgery Medical Center
$553.00Published rateApac Surgical Center II, LLC, Apac Surgery Center II LLC
Apac Surgical Center II LLC
$300.00Published rateVance Thompson Vision Surgery Center Prof LLC, Vance Thompson Vision Surgery Center
$125.00Published ratePalmetto Endoscopy Center
$75.00Published rate
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See a sample payer proposalCPT 42550 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 42550 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 42550 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 42550. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 42550 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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