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See a sample rate comparisonCPT 42842 Fee Schedule
Last Verified: October 2026
Healthcare providers use this code to document and receive reimbursement for visits that address high-level medical decision-making, often including multiple diagnoses or prescription management.
Radical Resct Of Tonsil Tonsillar Pillars &/Or Retromolar Trig, Radical Resection Of Tonsil Tonsillar Pillars And/Or Retromolar Trig
| Key Fact | Detail |
|---|---|
| Service Type | Surgery Surgical Procedures on the Digestive System |
| Common Place of Service | 21 - Inpatient Hospital 22 - On Campus Outpatient Hospital |
| Common Modifiers | 51 - Multiple procedures GC - Service performed by resident under supervision |
| Complexity Level | High |
| Medicare Fee Schedule | $910.84 national non-facility rate (2026) · View Medicare rates for 42842 |
| Medicaid Fee Schedule | $727.05 median of the 8 states in the free preview · View Medicaid rates for 42842 |
National average reimbursement for CPT 42842 by major payers:
$1,354.72
$1,307.38
$1,466.12
$1,620.16
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CPT 42842
5 of 25 sample ratesHigher to lower in this preview
Surgery Center, LLC
The Surgery Center, LLC
$7,081.00Published rateMississippi Medical Plaza, Lc, Mississippi Valley Surgery Center
Mississippi Medical Plaza, L.C.
$2,204.00Published ratePort Arthur Surgical Center, LLC, Gulf Coast Surgery Center
Port Arthur Surgical Center LLC
$1,550.00Published rateGalleria Surgery Center LLC
$1,200.00Published rateLive Oak Endoscopy Center, LLC
Live Oak Endoscopy Center
$440.00Published rate
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Payer Contract Negotiation
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See a sample payer proposalCPT 42842 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 42842 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 42842 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 |
| 42842-CPT | High | Radical Resct Of Tonsil Tonsillar Pillars &/Or Retromolar Trig, Radical Resection Of Tonsil Tonsillar Pillars And/Or Retromolar Trig |
| 42845-CPT | High | Radical Resct Of Tonsil Tonsillar Pillars &/Or Retromolar Trig, Radical Resection Of Tonsil Tonsillar Pillars And/Or Retromolar Trig |
| 42860-CPT | Moderate | Exc Tonsil Tags |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 42842. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 42842 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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