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See a sample rate comparisonCPT 42699 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.
Unlisted Proc Salivary Gland Or Ducts, Unlisted Procedure Salivary Glands Or Ducts
| 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 | RT - Right side of body LT - Left side of body |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 42699 |
| Medicaid Fee Schedule | $915.175 median of the 2 states in the free preview · View Medicaid rates for 42699 |
National average reimbursement for CPT 42699 by major payers:
$972.26
$57.14
$1,418.67
$910.49
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CPT 42699
5 of 25 sample ratesHigher to lower in this preview
South Campus Surgery Center
$3,922.00Published rateVenture Ambulatory Surgery Center LLC
$855.00Published rateMaple Lawn Surgery Center
Maple Lawn Surgery Center, LLC
$574.00Published rateMelville Sc LLC, Melville Surgery Center
Melville Surgery Center, LLC
$388.00Published rateAesthetic Surgery Center Of Eugene Inc
$116.00Published rate
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See a sample payer proposalCPT 42699 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 42699 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 42699 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 |
|---|---|---|
| 42699-CPT | Moderate | Unlisted Proc Salivary Gland Or Ducts, Unlisted Procedure Salivary Glands Or Ducts |
| 42830-CPT | Moderate | Adenoidectomy, Primary; Under Age 12 |
| 42999-CPT | High | Unlisted Proc Pharynx Adenoids Or Tonsils, Unlisted Procedure Pharynx Adenoids Or Tonsils |
| 43020-CPT | Moderate | Esophagotomy Cervical Approac, Esophagotomy Cervical Approach With Removal Of Foreignbody Esophagotomy Cervical Approach With Removal Of Foreign |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 42699. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 42699 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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