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See a sample rate comparisonCPT 42870 Fee Schedule
Last Verified: October 2026
Healthcare providers use this code to document and receive reimbursement for visits that address moderate-level medical decision-making, often including multiple diagnoses or prescription management.
Xcision/Destruct Lingual Tonsil Any Mthod (Sepa Proc, Excision Or Destruction Lingual Tonsil Any Method (Separate Procedure
| Key Fact | Detail |
|---|---|
| Service Type | Surgery Surgical Procedures on the Digestive System |
| Common Place of Service | 22 - On Campus Outpatient Hospital 24 - Ambulatory Surgical Center |
| Common Modifiers | GC - Service performed by resident under supervision 59 - Distinct Procedural Service |
| Complexity Level | Moderate |
| Medicare Fee Schedule | $548.44 national non-facility rate (2026) · View Medicare rates for 42870 |
| Medicaid Fee Schedule | $446.585 median of the 8 states in the free preview · View Medicaid rates for 42870 |
National average reimbursement for CPT 42870 by major payers:
$760.01
$772.54
$833.03
$958.71
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CPT 42870
5 of 25 sample ratesHigher to lower in this preview
Memorial Hermann Endoscopy & Surgery Center North Houston, LLC, North Houston Endoscopy & Surgery Center
$5,729.00Published rateRattner Vascular Medical Center Asc LLC
$1,887.00Published rateSoutheastern Interventional Pain Asc LLC
$1,300.00Published rateRogers Ar Ophthalmology Asc LLC, Boozman-Hof Eye Surgery & Laser Center
Rogers Ar Ophthalmology Asc LLC
$958.00Published rateAmbulatory Foot And Ankle Center, Inc.
Ambulatory Foot And Ankle Center Inc
$552.00Published rate
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See a sample payer proposalCPT 42870 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 42870 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 42870 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 |
|---|---|---|
| 42700-CPT | Moderate | I&D Abscess Peritonsilar |
| 42860-CPT | Moderate | Exc Tonsil Tags |
| 42870-CPT | Moderate | Xcision/Destruct Lingual Tonsil Any Mthod (Sepa Proc, Excision Or Destruction Lingual Tonsil Any Method (Separate Procedure |
| 42960-CPT | Moderate | Control Oropharyngeal Hemorrha, Control Oropharyngeal Hemorrhage Primary Or Secondary (Eg Posttonsillectomy) Simple Control Oropharyngeal Hemorrhage Primary Or Secondary (Eg |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 42870. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 42870 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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