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See a sample rate comparisonCPT 42810 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.
Xcision Branchial Clft Cyst Or Vestig Confined To Skin & Subcuta, Excision Branchial Cleft Cyst Or Vestige Confined To Skin And Subcuta
| Key Fact | Detail |
|---|---|
| Service Type | Surgery Surgical Procedures on the Digestive System |
| Common Place of Service | 22 - On Campus Outpatient Hospital 24 - Ambulatory Surgical Center |
| Common Modifiers | RT - Right side of body LT - Left side of body |
| Complexity Level | Moderate |
| Medicare Fee Schedule | $386.11 national non-facility rate (2026) · View Medicare rates for 42810 |
| Medicaid Fee Schedule | $304.24 median of the 8 states in the free preview · View Medicaid rates for 42810 |
National average reimbursement for CPT 42810 by major payers:
$500.41
$508.44
$558.29
$471.88
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CPT 42810
5 of 25 sample ratesHigher to lower in this preview
The Emory Clinic Inc, Emory Orthopaedic Surgery Center
Emory University
$3,624.00Published ratePhysicians Surgery Center Of Chattanooga, LLC, Physicians Surgery Center Of Chattanooga
Physicians Surgery Center Of Chattanooga LLC
$2,307.00Published rateMontgomery Surgery Center Limited Partnership
$1,200.00Published rateEndoscopy Center Monroe LLC, Carolina Endoscopy Center Monroe
Endoscopy Center Monroe LLC
$850.00Published rateLori Baker
Deaconess Hospital Inc
$311.80Published rate
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See a sample payer proposalCPT 42810 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 42810 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 42810 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 |
|---|---|---|
| 42810-CPT | Moderate | Xcision Branchial Clft Cyst Or Vestig Confined To Skin & Subcuta, Excision Branchial Cleft Cyst Or Vestige Confined To Skin And Subcuta |
| 42815-CPT | Moderate | Excision Branchial Cleft Cyst, Excision Branchial Cleft Cyst Vestige Or Fistulaextending Beneath Subcutaneous Tissues Andor Into Pharynx |
| 42820-CPT | Moderate | Tonsillectomy & Adnoidectomy; Under Age |
| 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 42810. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 42810 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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