CPT 42830 Fee Schedule
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.
| 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 | • None • 51 - Multiple procedures • SG - Scene to Hospital ESRD facility |
| Complexity Level | Moderate |
| CMS | $211.22 Physician Fee Schedule |
National average reimbursement for CPT 42830 by major payers:
$276.85
$278.18
$308.85
$354.76
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
Select a payer to view fee schedule data Choose a payer from the options above to see rates for CPT 42830 | ||||||
United | 42830 | $2859.00 | 1609274505 - BAY AREA SURGICAL SPECIALIST SERVICES, LLC | 471556346 - (CA) BAY AREA SURGICAL SPECIALIST SERVICES LLC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 42830 | $1603.00 | 1053314013 - TRIA ORTHOPAEDIC CENTER LLC | 200034003 - (MN) TRIA ORTHOPAEDIC CENTER LLC | MN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 42830 | $2323.00 | 1578534459 - BOSTON OUT-PATIENT SURGICAL SUITES, LLC | 270050256 - (MA) BOSTON OUT-PATIENT SURGICAL SUITES, LLC | MA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 42830 | $819.50 | 1942278692 - FOLSOM OUTPATIENT SURGERY CENTER, LP, FOLSOM SURGERY CENTER | 202468634 - (CA) FOLSOM OUTPATIENT SURGERY CENTER LP | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 42830 | $2307.00 | 1154323988 - CENTRAL VIRGINIA SURGI-CENTER LP, SURGI-CENTER OF CENTRAL VIRGINIA | 752967162 - (VA) CENTRAL VIRGINIA SURGICENTER LP | VA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 42830 | $852.00 | 1538581897 - SURGERY CENTER OF ATLANTA, LLC, SURGERY CENTER OF ATLANTA | 352491038 - (GA) SURGERY CENTER OF ATLANTA | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 42830 | $4304.00 | 1184937468 - GRASS VALLEY OUTPATIENT SURGERY CENTER LP, GRASS VALLEY SURGERY CENTER | 272185264 | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 42830 | $1420.00 | 1396700753 - HALCYON LASER & SURGERY CENTER, INC. | 770410936 - (CA) HALCYON LASER SURGERY CENTER INC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 42830 | $900.00 | 1447388574 - MACON PAIN CENTER, P.C. | 582452607 - (GA) MACON PAIN CENTER, PC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 42830 | $2266.00 | 1548226442 - ARTHROSCOPIC & LASER SURGERY CENTER OF SAN DIEGO LP | 631166884 - (CA) ARTHROSCOPIC & LASER SURGERY CENTER OF SAN DIEGO, LP | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 42830 | $559.00 | 1639203888 - VALLEY MEDICAL GROUP, P.C., VALLEY MEDICAL GROUP AMBULATORY SURGERY & PROCEDURES CENTER | 42945394 - (MA) VALLEY MEDICAL GROUP, P.C. | MA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 42830 | $2307.00 | 1942472931 - SURGCENTER OF GLEN BURNIE, SURGCENTER OF GLEN BURNIE, LLC | 261572774 - (MD) SURGCENTER OF GLEN BURNIE, LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 42830 | $2101.00 | 1336209451 - SADDLE RIVER VALLEY SURGICAL CENTER LLC, SADDLE RIVER VALLEY SURGICAL CENTER LLC | 201250583 - (NJ) SADDLE RIVER VALLEY SURGICAL CENTER LLC | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 42830 | $819.50 | 1972831998 - SAN DIEGO SKIN, INC. | 203245033 - (CA) SAN DIEGO SKIN, INC M MARK MOFID MD APC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 42830 | $819.50 | 1235797630 - AUSTIN GI SURGICENTER, LLC, AUSTIN ENDOSCOPY CENTER | 301073754 - (TX) AUSTIN GI SURGICENTER LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
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CPT 42830 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 42830 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 42830 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 42830. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 42830 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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