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See a sample rate comparisonCPT 42700 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.
I&D Abscess Peritonsilar
| Key Fact | Detail |
|---|---|
| Service Type | Surgery Surgical Procedures on the Digestive System |
| Common Place of Service | 23 - Emergency Room 11 - Office |
| Common Modifiers | AG - Primary physician LT - Left side of body |
| Complexity Level | Moderate |
| Medicare Fee Schedule | $199.07 national non-facility rate (2026) · View Medicare rates for 42700 |
| Medicaid Fee Schedule | $155.095 median of the 8 states in the free preview · View Medicaid rates for 42700 |
National average reimbursement for CPT 42700 by major payers:
$242.07
$249.68
$276.12
$308.13
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CPT 42700
5 of 25 sample ratesHigher to lower in this preview
Iu Health Arnett Hospital, Inc, Arnett Surgery Center, LLC
Indiana University Health Arnett Inc
$5,333.00Published rateWisconsin Institute Of Surgical Excellence LLC
$371.00Published rateValley Ambulatory Surgical Center
$143.00Published rateHenderson Surgery Center
Henderson Surgery Center LLC
$98.00Published rateArkansas Center For Surgical Excellence
$57.00Published rate
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Payer Contract Negotiation
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See a sample payer proposalCPT 42700 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 42700 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 42700 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 |
|---|---|---|
| 42700-CPT | Moderate | I&D Abscess Peritonsilar |
| 42720-CPT | Moderate | Ncision & Drain Absces; Retropharyng Or Parapharyngeal Intr, Incision And Drainage Abscess; Retropharyngeal Or Parapharyngeal Intr |
| 42725-CPT | High | Ncision & Drain Absces; Retropharyng Or Parapharyngeal Exte, Incision And Drainage Abscess; Retropharyngeal Or Parapharyngeal Exte |
| 42821-CPT | Moderate | T&A Age 12 And Over |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 42700. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 42700 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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