CPT 42831 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 |
| Medicare Fee Schedule | View Medicare rates for 42831 |
National average reimbursement for CPT 42831 by major payers:
$297.08
$300.61
$332.30
$384.35
| 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 42831 | ||||||
United | 42831 | $2859.00 | 1295246981 - SURGCENTER OF SAN DIEGO, LLC, ADVANCED SURGERY CENTER OF NORTH COUNTY | 820615296 - (CA) SURGCENTER OF SAN DIEGO | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 42831 | $2388.00 | 1326527680 - INTRACOASTAL SURGERY CENTER, LLC | 824525706 - (FL) INTRACOASTAL SURGERY CENTER LL | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 42831 | $588.00 | 1053391870 - NORTHWEST SURGERY CENTER, LTD, NORTHWEST SURGERY CENTER RED OAK | 760452319 - (TX) NORTHWEST SURGERY CENTER LTD | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 42831 | $3344.00 | 1861825986 - VADNAIS HEIGHTS SURGERY CENTER LLC, VADNAIS HEIGHTS SURGERY CENTER | 371866891 | MN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 42831 | $588.00 | 1164976478 - FRANCISCAN MEDICAL GROUP, THE DOCTORS CLINIC AMBULATORY SURGICAL CENTER, A PART OF THE FRANCISCA | 911939739 - FRANCISCAN MEDICAL GROUP | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 42831 | $819.50 | 1376194431 - ASCENT SURGERY CENTER LLC | 823347568 - (TX) ASCENT SURGERY CENTER LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 42831 | $588.00 | 1609103399 - TOURNEY PLAZA SURGICAL CENTER | 262034187 - (CA) TOURNEY PLAZA SURGICAL CENTER | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 42831 | $1446.00 | 1588427991 - LAKELAND REGIONAL HEALTH SURGERY CENTER, LLC | 934616298 | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 42831 | $4617.00 | 1780613521 - LITCHFIELD HILLS SURGERY CENTER | 562441789 - (CT) LITCHFIELD HILLS SURGERY CENTER | CT | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 42831 | $588.00 | 1447212337 - PUGET SOUND GASTROENTEROLOGY, PLLC, EVERGREEN ENDOSCOPY CENTER | 911123468 - (WA) PUGET SOUND GASTROENTEROLOGY, P.S. | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 42831 | $526.00 | 1720833163 - MIDWEST EYE CENTER | 363010536 - (IL) MIDWEST EYE CENTER | IL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 42831 | $986.00 | 1295700086 - WESTERN WASHINGTON ENDOSCOPY CENTERS, LLC | 200289310 - (WA) WESTERN WASHINGTON ENDOSCOPY CENTERS LLC | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 42831 | $1403.00 | 1487782637 - EYEASSOCIATES SURGERY CENTER, INC | 581362384 | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 42831 | $1290.00 | 1205317054 - SKYLINE SURGERY CENTER, LLC, SKYLINE EYE SURGERY CENTER | 824134934 - (CO) SKYLINE SURGERY CENTER LLC | CO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 42831 | $588.00 | 1285664466 - NEWPORT MULTI SPECIALTY SURGERY CENTER LLC | 710874859 - (CA) NEWPORT MULTI SPECIALTY SURGERY CENTER LLC | CA | 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 42831 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 42831 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 42831 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 42831. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 42831 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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