CPT 42892 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 • 24 - Ambulatory Surgical Center |
| Common Modifiers | • None • 58 - Staged or related procedure during postoperative period • AS - PA/NP/CNS assistant at surgery |
| Complexity Level | High |
| CMS | $1,801.38 Physician Fee Schedule |
National average reimbursement for CPT 42892 by major payers:
$2,539.92
$2,424.95
$2,601.51
$3,034.18
| 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 42892 | ||||||
United | 42892 | $2765.00 | 1053508077 - JOURNEY LITE OF CINCINNATI, LLC | 208861350 - (OH) JOURNEYLITE OF CINCINNATI, LLC | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 42892 | $5433.00 | 1306421268 - COLORADO UROLOGIC SURGERY CENTER, LLC, COLORADO UROLOGIC SURGERY CENTER | 851926897 - (CO) COLORADO UROLOGIC SURGERY CENTER LLC | CO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 42892 | $6506.00 | 1952814386 - ADVANCED SURGICAL CARE OF BOERNE, LLC | 821680961 - (TX) ADVANCED SURGICAL CARE OF BOERNE LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 42892 | $2552.00 | 1942414750 - HAMILTON EYE INSTITUTE SURGERY CENTER, L.P. | 202873438 - (TN) HAMILTON EYE INSTITUTE SURGERY CENTER LP | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 42892 | $1633.00 | 1336138635 - EYE SURGICAL SPECIALISTS OF NEW JERSEY, SURGERY CENTER OF CENTRAL NEW JERSEY | 223411416 - (NJ) EYE SURGICAL SPECIALISTS OF NEW JERSEY | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 42892 | $2000.00 | 1932657335 - VOLUSIA ORTHOPAEDIC TRAUMA CALL ASSOCIATES LLC, EAST COAST SURGERY CENTER | 300950557 - (FL) VOLUSIA ORTHOPAEDIC TRAUMA CALL ASSOCIATES LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 42892 | $678.00 | 1689657058 - CENTER FOR ADVANCED EYE SURGERY, LTD | 341866635 - (OH) CENTER FOR ADVANCED EYE SURGERY LTD | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 42892 | $2756.00 | 1497090740 - OLOL PONTCHARTRAIN SURGERY CENTER, LLC, OUR LADY OF THE LAKE PONTCHARTRAIN SURGERY CENTER | 461379031 - (LA) OLOL PONTCHARTRAIN SURGERY CENTE | LA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 42892 | $1500.00 | 1205845740 - THE UROLOGY CENTER LLC | 311579733 - (OH) THE UROLOGY CENTER LLC | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 42892 | $4781.00 | 1063099190 - ASCENSION SAINT THOMAS LEBANON SURGERY CENTER LLC, LEBANON SURGERY CENTER | 862679471 | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 42892 | $4781.00 | 1962788059 - SURGCENTER OF SILVER SPRING, LLC | 452950933 - (MD) SURGCENTER OF SILVER SPRING LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 42892 | $3935.00 | 1104341353 - BANNER PEORIA SURGERY CENTER LLC | 901182685 - (AZ) BANNER PEORIA SURGERY CENTER LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 42892 | $9251.00 | 1720543481 - SURGICAL SUITES OF COASTAL VIRGINIA, LLC | 833205375 - (VA) SURGICAL SUITES OF COASTAL VIRGINIA LLC | VA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 42892 | $629.00 | 1528274719 - LASER AND VISION SURGERY CENTER, LLC | 61553382 - (CT) LASER AND VISION SURGERY CENTER LLC | CT | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 42892 | $3763.00 | 1194344606 - TIDELANDS HEALTH ASC LLC, TIDELANDS HEALTH SURGERY CENTER AT THE MARKET COMMON | 611930163 - (SC) TIDELANDS HEALTH ASC LLC | SC | 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 42892 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 42892 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 42892 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 42892. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 42892 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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