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CPT 42844 Fee Schedule

Last Verified: December 2025

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.

Resect Tonsil Radical W Local Flap
Key FactDetail
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 LevelHigh
CMS$1,333.65 Physician Fee Schedule

National average reimbursement for CPT 42844 by major payers:

bcbs

$1,841.25

uhc

$1,820.60

aetna

$1,965.31

cigna

$2,272.09

Preview provider-level rates for...
For billing codeCPT 42844
PayerCodeRateNPITax IDStateSpecialty

Select a payer to view fee schedule data

Choose a payer from the options above to see rates for CPT 42844

United
42844$5779.001417912098 - BAILEY SQUARE AMBULATORY SURGICAL CENTER, LTD752467365 - (TX) BAILEY SQUARE AMBULATORY SURGICAL CENTER LTDTXAmbulatory Surgical Clinic/Center (261QA1903X)
United
42844$1500.001528297140 - ISPM ASC AT COVINGTON, LLC264485600 - (GA) ISPM ASC AT COVINGTON LLCGAAmbulatory Surgical Clinic/Center (261QA1903X)
United
42844$1790.001871538694 - SOUTHWEST ENDOSCOPY LTD850452091 - (NM) SOUTHWEST ENDOSCOPY LTDNMAmbulatory Surgical Clinic/Center (261QA1903X)
United
42844$3654.001962148510 - PVSCG, LLC842112909 - (TX) PVSCG LLCTXAmbulatory Surgical Clinic/Center (261QA1903X)
United
42844$2700.001942637301 - MICHIANA SURGERY CENTER, LLC461007801 - (IN) MICHIANA SURGERY CENTER LLCINAmbulatory Surgical Clinic/Center (261QA1903X)
United
42844$4313.001942231204 - SURGICAL INSTITUTE, LLC810911558 - (NJ) SURGICAL INSTITUTE LLCNJAmbulatory Surgical Clinic/Center (261QA1903X)
United
42844$4342.001033351119 - SSM ST CLARE SURGICAL CENTER LLC, SSM ST CLARE SURGICAL CENTER261439695 - (MO) SSM ST CLARE SURGICAL CENTER LLCMOAmbulatory Surgical Clinic/Center (261QA1903X)
United
42844$5249.001659748184 - SURGCENTER OF THE POTOMAC, LLC472311914 - (MD) SURGCENTER OF THE POTOMAC, LLCMDAmbulatory Surgical Clinic/Center (261QA1903X)
United
42844$2176.001710082680 - MBC AMBULATORY SURGERY CENTER, LP, MANN CATARACT SURGERY CENTER752841034 - (TX) MBC AMBULATORY SURGERY CENTER LPTXAmbulatory Surgical Clinic/Center (261QA1903X)
United
42844$3208.001376885400 - MD ANAHEIM SURGERY CENTER INC462311690 - (CA) MD ANAHEIM SURGERY CENTER INCCAAmbulatory Surgical Clinic/Center (261QA1903X)
United
42844$1550.001457323107 - BOCA RATON OPHTHALMOLOGY ASC LLC, OUTPATIENT SURGERY CENTER OF BOCA RATON626350623 - (FL) BOCA RATON OPHTHALMOLOGY ASC LLCFLAmbulatory Surgical Clinic/Center (261QA1903X)
United
42844$10614.001346792165 - HSS ASC OF MANHATTAN LLC, HSS ASC OF MANHATTAN471353602NYAmbulatory Surgical Clinic/Center (261QA1903X)
United
42844$2660.001093726796 - ROCKY MOUNTAIN EYE SURGERY CENTER INC810493712 - (MT) ROCKY MOUNTAIN EYE SURGERY CENTER INCMTAmbulatory Surgical Clinic/Center (261QA1903X)
United
42844$4310.001245657840 - SURGCENTER OF PLANO LLC462873916 - (TX) SURGCENTER OF PLANO, LLCTXAmbulatory Surgical Clinic/Center (261QA1903X)
United
42844$3454.001073816690 - PENN STATE HERSHEY ENDOSCOPY CENTER LLC274000022 - (PA) PENN STATE HERSHEY ENDOSCOPY CENTER LLCPAAmbulatory Surgical Clinic/Center (261QA1903X)
United
99202$100.0012345678901234567890CACardiologist
United
99202$100.0012345678901234567890CACardiologist
United
99202$100.0012345678901234567890CACardiologist
United
99202$100.0012345678901234567890CACardiologist
United
99202$100.0012345678901234567890CACardiologist
United
99202$100.0012345678901234567890CACardiologist
United
99202$100.0012345678901234567890CACardiologist
United
99202$100.0012345678901234567890CACardiologist
United
99202$100.0012345678901234567890CACardiologist
United
99202$100.0012345678901234567890CACardiologist

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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.

CodeComplexityDescription
42842-CPTHighRadical Resec Tonsil/Pillars/Trigone;Wo
42844-CPTHighResect Tonsil Radical W Local Flap
42845-CPTHighRadical Resec Tonsil,Etc;Closure W Other
42900-CPTModerateSuture 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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