CPT 42962 Fee Schedule
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.
| Key Fact | Detail |
|---|---|
| Service Type | • Surgery • Surgical Procedures on the Digestive System |
| Common Place of Service | • 22 - On Campus Outpatient Hospital • 21 - Inpatient Hospital |
| Common Modifiers | • None • 78 - Return to OR - related procedure • 79 - Unrelated procedure - postop period |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 42962 |
National average reimbursement for CPT 42962 by major payers:
$667.41
$692.62
$740.77
$865.11
| 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 42962 | ||||||
United | 42962 | $1320.00 | 1932613643 - GRAND VIEW SURGERY CENTER AT HARLEYSVILLE, LLC | 822907231 - (PA) GRAND VIEW SURGERY CENTER AT HAR | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 42962 | $2206.00 | 1548784556 - NORTH ATLANTIC SURGICAL SUITES, LLC | 821540859 - (NH) NORTH ATLANTIC SURGICAL SUITES, LLC | NH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 42962 | $1223.00 | 1770990376 - ADVANCED VISION SURGERY CENTER LLC | 453791209 - (VA) ADVANCED VISION SURGERY CENTER LLC | VA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 42962 | $1226.00 | 1538117841 - SHELBY BAPTIST AMBULATORY SURGERY CENTER, LLC, SHELBY AMBULATORY SURGERY AT THE PHYSICIANS CENTER | 203150946 - (AL) SHELBY BAPTIST AMBULATORY SURGERY CENTER, LLC | AL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 42962 | $2353.00 | 1962671487 - HYDE PARK SURGERY CENTER, LLC, HYDE PARK SURGERY CENTER, LP | 421731685 | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 42962 | $1000.00 | 1528453396 - SOUTH POINTE SURGICAL CENTER | 465558778 - (UT) SOUTH POINTE SURGICAL CENTER, LLC | UT | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 42962 | $1685.00 | 1275629081 - VISION CARE OF MAINE LLC | 10525143 - (ME) VISION CARE OF MAINE LLC | ME | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 42962 | $910.10 | 1013117621 - MATTHEW GILBERT | 350593390 - DEACONESS HOSPITAL INC | IN | Emergency Medicine Physician (207P00000X) |
United | 42962 | $3373.00 | 1003842626 - AMBULATORY CENTER FOR ENDOSCOPY, LLC | 200064962 | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 42962 | $1800.00 | 1295848752 - ESSEX SURGICAL ARTS SURGERY CENTER, LLC, MOBILE VASCULAR PHYSICIANS | 202242123 - (NJ) ESSEX SURGICAL ARTS SURGERY | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 42962 | $1200.00 | 1790197606 - UROLOGY HEALTH SURGERY CENTER, LLC | 260412126 - (PA) UROLOGY HEALTH SURGERY CENTER LLC | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 42962 | $694.00 | 1053345082 - EYE SURGERY LIMITED LLC, VIRGINIA CENTER FOR EYE SURGERY | 522406179 - (VA) EYE SURGERY LIMITED, LLC | VA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 42962 | $1200.00 | 1255894051 - NEW JERSEY INTERVENTIONAL ASSOCIATES LLC | 262178516 | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 42962 | $889.00 | 1376518357 - ORLANDO FL ENDOSCOPY ASC LLC, CITRUS AMBULATORY SURGERY CENTER | 202873015 - ORLANDO FL ENDOSCOPY ASC LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 42962 | $850.00 | 1467788729 - WATERFORD SURGICAL CENTER, LLC | 271110813 - (MI) WATERFORD SURGICAL CENTER | MI | 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 42962 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 42962 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 42962 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 |
|---|---|---|
| 42960-CPT | Moderate | Control Hemorrhage Oropharynx Simp |
| 42961-CPT | Moderate | Control Oropharyngeal Hemorrhage (Primary Or Secondary, Eg, Posttonsillectomy); Complicated, Requiring Hospitalization |
| 42962-CPT | Moderate | Control Oropharyngeal Hemorrhage (Primary Or Secondary, Eg, Posttonsillectomy); With Secondary Surgical Intervention |
| 42971-CPT | Moderate | Control Of Nasopharyngeal Hemorrhage (Primary Or Secondary, Eg, Postadenoidectomy); Complicated, Requiring Hospitalization |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 42962. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 42962 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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