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See a sample rate comparisonCPT 42808 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.
Exc./Dest.;Lesion/Pharynx,Any Method
| Key Fact | Detail |
|---|---|
| Service Type | Surgery Surgical Procedures on the Digestive System |
| Common Place of Service | 11 - Office 22 - On Campus Outpatient Hospital 24 - Ambulatory Surgical Center |
| Common Modifiers | 51 - Multiple procedures 59 - Distinct Procedural Service |
| Complexity Level | Moderate |
| Medicare Fee Schedule | $234.47 national non-facility rate (2026) · View Medicare rates for 42808 |
| Medicaid Fee Schedule | $184.72 median of the 8 states in the free preview · View Medicaid rates for 42808 |
National average reimbursement for CPT 42808 by major payers:
$292.28
$303.22
$322.94
$277.35
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CPT 42808
5 of 25 sample ratesHigher to lower in this preview
Memorial Hermann Surgery Center Kingsland LLC, Memorial Hermann Surgery Center Kingsland
$5,048.00Published rateSpringfield Clinic LLP, Springfield Clinic Ambulatory Surgery Center
Springfield Clinic, LLP
$2,730.00Published rateMaryland Surgery Center For Women LLC, Maryland Surgery Center
Maryland Surgery Center For Women, LLC
$1,648.00Published rateSouthern Oklahoma Surgical Center Inc
Southern Oklahoma Surgical Center, Inc.
$1,363.00Published rateOrthoarkansas Surgery Center LLC
$925.00Published rate
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See a sample payer proposalCPT 42808 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 42808 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 42808 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 |
|---|---|---|
| 42808-CPT | Moderate | Exc./Dest.;Lesion/Pharynx,Any Method |
| 42809-CPT | Moderate | Remove Fb Pharynx |
| 42892-CPT | High | Revision Of Pharyngeal Walls, Resection Of Lateral Pharyngeal Wall Or Pyriform Sinus Direct Closure By Advancement Of Lateral And Posterior Pharyngeal Walls |
| 42894-CPT | High | Revision Of Pharyngeal Walls, Resection Of Pharyngeal Wall Requiring Closure With Myocutaneous Or Fasciocutaneous Flap Or Free Muscle Skin Or Fascial Flap With Microvascular Anastomosis |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 42808. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 42808 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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