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See a sample rate comparisonCPT 42844 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.
Extensive Surgery Of Throat, Radical Resection Of Tonsil Tonsillar Pillars And Or Retromolar Trigone Closure With Local Flap Eg Tongue Buccal
| 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 58 - Staged or related procedure during postoperative period |
| Complexity Level | High |
| Medicare Fee Schedule | $1,228.49 national non-facility rate (2026) · View Medicare rates for 42844 |
| Medicaid Fee Schedule | $993.705 median of the 8 states in the free preview · View Medicaid rates for 42844 |
National average reimbursement for CPT 42844 by major payers:
$1,841.25
$1,820.60
$1,965.31
$2,225.52
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CPT 42844
5 of 25 sample ratesHigher to lower in this preview
Medical City Specialty Surgicenter Of Dallas, LLC, Medical City Orthopedic & Spine Surgery Center Dallas
Medical City Specialty Surgicenter Of Dallas LLC
$9,147.00Published rateSsm St Clare Surgical Center LLC, Ssm St Clare Surgical Center
Ssm St Clare Surgical Center LLC
$4,342.00Published ratePeachtree Orthopaedic Surgery Center At Perimeter
$3,085.00Published ratePhysicians Surgery Center LLC, National Spine & Ortho Surgery Center Of Ft. Myers
Physicians Surgery Center LLC
$2,000.00Published rateAnderson Endoscopy Center LLC
$642.00Published rate
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See a sample payer proposalCPT 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.
| Code | Complexity | Description |
|---|---|---|
| 42842-CPT | High | Radical Resct Of Tonsil Tonsillar Pillars &/Or Retromolar Trig, Radical Resection Of Tonsil Tonsillar Pillars And/Or Retromolar Trig |
| 42844-CPT | High | Extensive Surgery Of Throat, Radical Resection Of Tonsil Tonsillar Pillars And Or Retromolar Trigone Closure With Local Flap Eg Tongue Buccal |
| 42845-CPT | High | Radical Resct Of Tonsil Tonsillar Pillars &/Or Retromolar Trig, Radical Resection Of Tonsil Tonsillar Pillars And/Or Retromolar Trig |
| 42900-CPT | Moderate | Suture Pharynx Wound/Injury |
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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