CPT 42844 Fee Schedule
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.
| 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 | • None • 51 - Multiple procedures • 58 - Staged or related procedure during postoperative period |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 42844 |
National average reimbursement for CPT 42844 by major payers:

$1,841.25

$1,820.60

$1,965.31

$2,272.09
| 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 42844 | ||||||
United | 42844 | $3160.00 | 1235466863 - AESTHETIC ASSOCIATES INC., P.S, SEATTLE FACIAL PLASTIC SURGERY CENTER | 911650765 - (WA) AESTHETIC ASSOCIATES INC PS | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 42844 | $642.00 | 1396192241 - ANDERSON ENDOSCOPY CENTER LLC | 811947476 - (OH) ANDERSON ENDOSCOPY CENTER LLC | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 42844 | $3085.00 | 1730463753 - PEACHTREE ORTHOPAEDIC SURGERY CENTER AT PERIMETER | 201285759 - (GA) PEACHTREE ORTHOPAEDIC SURGERY CENTER AT PERIMETER | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 42844 | $1167.00 | 1801457478 - DIALYSIS ACCESS CENTER, LLC | 834488032 - (OH) DIALYSIS ACCESS CENTER LLC | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 42844 | $3001.00 | 1497746747 - PHYSICIANS' SURGERY CENTER OF VICTORVILLE LLC | 260057464 - (CA) PHYSICIANS SURGERY CENTER OF VICTORVILLE, LLC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 42844 | $1974.00 | 1093214819 - PREMIER SURGICAL CENTER, LLC | 823438730 - (MS) PREMIER SURGICAL CENTER LLC | MS | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 42844 | $2400.00 | 1437120953 - MONTGOMERY SURGERY CENTER LIMITED PARTNERSHIP | 521401868 - (MD) MONTGOMERY SURGERY CENTER LIMITED PARTNERSHIP | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 42844 | $3646.00 | 1942231493 - TAYLOR STATION SURGICAL CENTER LTD | 311459910 - (OH) TAYLOR STATION SURGICAL CENTER | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 42844 | $2734.00 | 1467783233 - SOUTH SOUND SURGERY, PLLC, AUBURN SURGICAL CENTER | 204413058 - (WA) SOUTH SOUND SURGERY PLLC | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 42844 | $3600.00 | 1003870825 - PINELLAS SURGERY CENTER, LLC, CENTER FOR SPECIAL SURGERY | 752563226 - (FL) PINELLAS SURGERY CENTER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 42844 | $3027.00 | 1225091630 - GRAMERCY SURGERY CENTER, LTD | 752399524 | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 42844 | $2964.00 | 1467195057 - BONE AND JOINT SURGICAL SUITES, LLC | 872413013 - (FL) BONE AND JOINT SURGICAL SUITES LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 42844 | $5810.00 | 1154369114 - CHRISTUS SANTA ROSA PASC-SAN ANTONIO LLC, CHRISTUS SURGERY CENTER - ALAMO HEIGHTS | 412092141 - (TX) CHRISTUS SRPASC - SAN ANTONIO, LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 42844 | $6286.00 | 1659772648 - SURGICAL SPECIALTY CENTER OF MID ATLANTIC, LLC | 465727021 - (MD) SURGICAL SPECIALTY CENTER OF MID-ATLANTIC, LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 42844 | $1126.93 | 1265160881 - LISA KOOP | 350593390 - DEACONESS HOSPITAL INC | IN | Certified Registered Nurse Anesthetist (367500000X) |
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 42844 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 42844 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 42844 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 42844. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 42844 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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