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 42825 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.
Tonsillectomy, Prim/2nd;Under Age 12
| Key Fact | Detail |
|---|---|
| Service Type | Surgery Surgical Procedures on the Digestive System |
| Common Place of Service | 24 - Ambulatory Surgical Center 22 - On Campus Outpatient Hospital |
| Common Modifiers | SG - Scene to Hospital ESRD facility 51 - Multiple procedures |
| Complexity Level | Moderate |
| Medicare Fee Schedule | $243.49 national non-facility rate (2026) · View Medicare rates for 42825 |
| Medicaid Fee Schedule | $197.41 median of the 8 states in the free preview · View Medicaid rates for 42825 |
National average reimbursement for CPT 42825 by major payers:
$340.15
$351.64
$384.71
$438.48
Compare published rates across providers.
Choose a payer to see a sample of rates for CPT 42825.
CPT 42825
5 of 25 sample ratesHigher to lower in this preview
Lutherville Endoscopy Center LLC
$2,655.00Published rateBaptist Surgery And Endoscopy Centers LLC, Baptist Health Surgery Center At South Palm
$1,954.00Published rateSouthwest Endoscopy Ltd
$1,116.00Published rateHattiesburg Ambulatory Surgery Center Lp, South Mississippi Surgery Center
Hattiesburg Ambulatory Surgery Center Lp
$1,056.00Published rateBassam Yousef
Deaconess Hospital Inc
$461.10Published 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 42825 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 42825 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 42825 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.
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 42825. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 42825 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 42825) and we'll show you how you compare in 15 minutes or less.