CPT 42971 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 | • 21 - Inpatient Hospital • 22 - On Campus Outpatient Hospital |
| Common Modifiers | • None • 58 - Staged or related procedure during postoperative period • 78 - Return to OR - related procedure |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 42971 |
National average reimbursement for CPT 42971 by major payers:
$599.59
$609.31
$630.66
$757.95
| 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 42971 | ||||||
United | 42971 | $912.00 | 1588328918 - HARLEM ROAD AMBULATORY SURGERY CENTER LLC | 833648797 - (NY) HARLEM ROAD AMBULATORY SURGERY CENTER LLC | NY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 42971 | $1064.00 | 1265534556 - SOUTH FLORIDA AMBULATORY SURGICAL CENTER LLC | 651093026 - (FL) SOUTH FLORIDA AMBULATORY SURGI | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 42971 | $2700.00 | 1518149954 - NEUROLOGICAL INSTITUTE AMBULATORY SURGICAL CENTER, LLC | 141983013 - (GA) NEUROLOGICAL INSTITUTE AMBULATORY SURGICAL CENTER LLC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 42971 | $350.00 | 1124116264 - BOSTON EYE SURGERY & LASER CENTER TRUST, BOSTON EYE SURGERY & LASER CENTER | 43092292 - (MA) BOSTON EYE SURGERY & LASER CENTER TRUST | MA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 42971 | $920.00 | 1801891668 - CASCADE SPINE CENTER, LLC | 113653049 - (OR) CASCADE SPINE CENTER LLC | OR | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 42971 | $545.00 | 1225077241 - CORTEZ FOOT SURGERY CENTER, P.A. | 650064196 - (FL) CORTEZ FOOT SURGERY CENTER PA | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 42971 | $384.00 | 1871052712 - KURESMART PAIN MANAGEMENT SURGERY CENTER-COLUMBIA LLC, CLEARWAY SURGERY CENTER OF COLUMBIA | 834028893 - (MD) KURESMART PAIN MANAGEMENT SURGERY CENTERCOLUMBIA LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 42971 | $2932.00 | 1710315619 - RIDGELINE SURGICENTER, LLC | 463848829 | UT | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 42971 | $1075.00 | 1841284742 - KLEINERT KUTZ SURGERY CENTER, LLC | 352095662 - (IN) KLEINERT KUTZ SURGERY CENTER LLC | IN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 42971 | $1028.00 | 1750363461 - BARKLEY SURGICENTER, LLC | 650428622 - (FL) BARKLEY SURGICENTER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 42971 | $375.00 | 1578088787 - VACCO LLC | 821221738 - (OH) VACCO LLC | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 42971 | $300.00 | 1871718270 - PRINCE GEORGES MULTI SPECIALTY SURGERY CENTER | 521842302 - (MD) PRINCE GEORGES MULTI SPECIALTY SURGERY CENTER | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 42971 | $285.00 | 1619049939 - ENDOSCOPY CENTER MONROE LLC, CAROLINA ENDOSCOPY CENTER MONROE | 260731594 - (NC) ENDOSCOPY CENTER MONROE LLC | NC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 42971 | $820.00 | 1952312399 - ZITELLI & BRODLAND PC, ZITELLI & BRODLAND ASF SOUTH | 251549973 - JOHN A. ZITELLI, MD, PC | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 42971 | $200.00 | 1013021682 - PHOENIX EYE SURGICAL CENTER PLC, CENTRAL PHOENIX SURGICAL CENTER | 860905556 - (AZ) PHOENIX EYE SURGICAL CENTER PL | AZ | 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 42971 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 42971 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 42971 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 |
|---|---|---|
| 42806-CPT | Moderate | Biopsy Nasopharynx Survey |
| 42960-CPT | Moderate | Control Hemorrhage Oropharynx Simp |
| 42970-CPT | Moderate | Control Of Nasopharyngeal Hemorrhage, Primary Or Secondary (Eg, Postadenoidectomy); Simple, With Posterior Nasal Packs, With Or Without Anterior Packs And/Or Cautery |
| 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 42971. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 42971 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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