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 42720 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.
Ncision & Drain Absces; Retropharyng Or Parapharyngeal Intr, Incision And Drainage Abscess; Retropharyngeal Or Parapharyngeal Intr
| Key Fact | Detail |
|---|---|
| Service Type | Surgery Surgical Procedures on the Digestive System |
| Common Place of Service | 21 - Inpatient Hospital 22 - On Campus Outpatient Hospital |
| Common Modifiers | AG - Primary physician GC - Service performed by resident under supervision |
| Complexity Level | Moderate |
| Medicare Fee Schedule | $446.57 national non-facility rate (2026) · View Medicare rates for 42720 |
| Medicaid Fee Schedule | $356.25 median of the 8 states in the free preview · View Medicaid rates for 42720 |
National average reimbursement for CPT 42720 by major payers:
$567.54
$598.31
$642.94
$633.10
Compare published rates across providers.
Choose a payer to see a sample of rates for CPT 42720.
CPT 42720
5 of 25 sample ratesHigher to lower in this preview
The Emory Clinic Inc, The Emory Clinic Lagrange Surgery Center
Emory University
$3,022.00Published rateSummit Ambulatory Surgical Center, LLC
$1,276.00Published rateNj Vein & Cosmetic Surgery Center, PA
Nj Vein Cosmetic Surgery Center PA
$1,025.00Published rateAffiliated Physicians & Surgeons, Ltd
Affiliated Physicians Surgeons Ltd
$669.00Published rateApollo Surgical Center LLC
$500.00Published 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 42720 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 42720 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 42720 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 |
| 42815-CPT | Moderate | Excision Branchial Cleft Cyst, Excision Branchial Cleft Cyst Vestige Or Fistulaextending Beneath Subcutaneous Tissues Andor Into Pharynx |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 42720. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 42720 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 42720) and we'll show you how you compare in 15 minutes or less.