Rate Benchmarking
Compare your rates with similar providers.
Select a published rate, define comparable providers, and see where that rate falls in your market.
See a sample rate comparisonCPT 42900 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.
Suture Pharynx Wound/Injury
| 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 | 59 - Distinct Procedural Service 51 - Multiple procedures |
| Complexity Level | Moderate |
| Medicare Fee Schedule | $288.92 national non-facility rate (2026) · View Medicare rates for 42900 |
| Medicaid Fee Schedule | $256.30 median of the 8 states in the free preview · View Medicaid rates for 42900 |
National average reimbursement for CPT 42900 by major payers:
$424.51
$455.45
$470.32
$548.57
Compare published rates across providers.
Choose a payer to see a sample of rates for CPT 42900.
CPT 42900
5 of 25 sample ratesHigher to lower in this preview
Los Gatos Surgical Center, A California Limited Partnership
$3,933.00Published ratePalm Beach Surgical Suites LLC
$1,233.00Published rateLegent Outpatient Surgery Euless, LLC, Legent Interventional Pain Center
Legent Outpatient Surgery Euless LLC
$771.00Published rateGulf Coast Surgical Center LLC
Gulf Coast Surgical Center, LLC
$640.00Published rateChildrens Surgery Center Of Malvern, LLC
Childrens Surgery Center Of Malvern LLC
$414.00Published rate
Get a free rate benchmark for your specialty.
Choose your state and specialty to build a report from payer-published rates.
Use market rates to prepare your payer proposal.
Payer Contract Negotiation
Draft a fee schedule renegotiation letter.
Use your fee schedule and market benchmarks to set target rates and draft a letter for your payer.
See a sample payer proposalCPT 42900 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 42900 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 42900 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 |
| 42892-CPT | High | Revision Of Pharyngeal Walls, Resection Of Lateral Pharyngeal Wall Or Pyriform Sinus Direct Closure By Advancement Of Lateral And Posterior Pharyngeal Walls |
| 42900-CPT | Moderate | Suture Pharynx Wound/Injury |
| 42950-CPT | Moderate | Pharyngoplasty |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 42900. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 42900 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.
FREE SAMPLE MARKET COMPARISON
Let's review your payer contracts side-by-side with the market.
Bring your top codes (like CPT 42900) and we'll show you how you compare in 15 minutes or less.