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 |
| CMS | $1,333.65 Physician Fee Schedule |
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 | $5779.00 | 1417912098 - BAILEY SQUARE AMBULATORY SURGICAL CENTER, LTD | 752467365 - (TX) BAILEY SQUARE AMBULATORY SURGICAL CENTER LTD | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 42844 | $1500.00 | 1528297140 - ISPM ASC AT COVINGTON, LLC | 264485600 - (GA) ISPM ASC AT COVINGTON LLC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 42844 | $1790.00 | 1871538694 - SOUTHWEST ENDOSCOPY LTD | 850452091 - (NM) SOUTHWEST ENDOSCOPY LTD | NM | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 42844 | $3654.00 | 1962148510 - PVSCG, LLC | 842112909 - (TX) PVSCG LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 42844 | $2700.00 | 1942637301 - MICHIANA SURGERY CENTER, LLC | 461007801 - (IN) MICHIANA SURGERY CENTER LLC | IN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 42844 | $4313.00 | 1942231204 - SURGICAL INSTITUTE, LLC | 810911558 - (NJ) SURGICAL INSTITUTE LLC | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 42844 | $4342.00 | 1033351119 - SSM ST CLARE SURGICAL CENTER LLC, SSM ST CLARE SURGICAL CENTER | 261439695 - (MO) SSM ST CLARE SURGICAL CENTER LLC | MO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 42844 | $5249.00 | 1659748184 - SURGCENTER OF THE POTOMAC, LLC | 472311914 - (MD) SURGCENTER OF THE POTOMAC, LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 42844 | $2176.00 | 1710082680 - MBC AMBULATORY SURGERY CENTER, LP, MANN CATARACT SURGERY CENTER | 752841034 - (TX) MBC AMBULATORY SURGERY CENTER LP | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 42844 | $3208.00 | 1376885400 - MD ANAHEIM SURGERY CENTER INC | 462311690 - (CA) MD ANAHEIM SURGERY CENTER INC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 42844 | $1550.00 | 1457323107 - BOCA RATON OPHTHALMOLOGY ASC LLC, OUTPATIENT SURGERY CENTER OF BOCA RATON | 626350623 - (FL) BOCA RATON OPHTHALMOLOGY ASC LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 42844 | $10614.00 | 1346792165 - HSS ASC OF MANHATTAN LLC, HSS ASC OF MANHATTAN | 471353602 | NY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 42844 | $2660.00 | 1093726796 - ROCKY MOUNTAIN EYE SURGERY CENTER INC | 810493712 - (MT) ROCKY MOUNTAIN EYE SURGERY CENTER INC | MT | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 42844 | $4310.00 | 1245657840 - SURGCENTER OF PLANO LLC | 462873916 - (TX) SURGCENTER OF PLANO, LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 42844 | $3454.00 | 1073816690 - PENN STATE HERSHEY ENDOSCOPY CENTER LLC | 274000022 - (PA) PENN STATE HERSHEY ENDOSCOPY CENTER LLC | PA | 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 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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