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 |
| CMS | $444.44 Physician Fee Schedule |
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 | $852.00 | 1437250248 - GEORGIA SURGICAL CENTER ON PEACHTREE, LLC | 582394271 - (GA) GEORGIA SURGICAL CENTER ON PEACHTREE LLC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 42971 | $456.00 | 1265624696 - CENTRAL OHIO UROLOGY SURGERY CENTER, LLC | 261240704 - (OH) CENTRAL OHIO UROLOGY SURGERY CENTER LLC | OH | 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 | $1064.00 | 1063099190 - ASCENSION SAINT THOMAS LEBANON SURGERY CENTER LLC, LEBANON SURGERY CENTER | 862679471 | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 42971 | $1215.00 | 1023113701 - SURGICAL CENTER OF CONNECTICUT LLC | 61552689 - (CT) SURGICAL CENTER OF CONNECTICUT | CT | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 42971 | $350.00 | 1922071315 - SENECA PA ASC LLC, THE SURGERY AND LASER CENTER | 621806254 - (PA) SENECA PA ASC, LLC | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 42971 | $109.00 | 1073588356 - DIGESTIVE HEALTH SPECIALISTS ENDOSCOPY CENTER ARIZONA, LLC | 201456252 - (AZ) DIGESTIVE HEALTH SPECIALISTS ENDOSCOPY CENTER ARIZONA LLC | AZ | 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 | $537.00 | 1407993132 - DIGESTIVE DISEASE ENDOSCOPY CENTER | 352597463 | CO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 42971 | $2002.00 | 1831117704 - MEDICAL HEIGHTS SURGERY CENTER, INC., KENTUCKY SURGERY CENTER | 843280181 - (KY) BAPTIST HEALTH SURGERY CENTER, L | KY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 42971 | $610.00 | 1093731101 - EAST BRUNSWICK SURGERY CENTER LLC, UNIVERSITY SURGICENTER | 20593133 - (NJ) EAST BRUNSWICK SURGERY CENTER | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 42971 | $2705.00 | 1023071560 - MEDICAL PLAZA AMBULATORY SURGERY CENTER ASSOCIATES, L.P., MEDICAL CITY SURGERY CENTER/FORT WORTH | 621489404 - (TX) MEDICAL PLAZA AMBULATORY SURGERY CENTER ASSOCIATES LP | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 42971 | $545.00 | 1053301473 - BAKER AMBULATORY SURGERY CENTER | 710839283 - (AR) BAKER AMBULATORY SURGERY CENTER | AR | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 42971 | $432.00 | 1982637492 - TOMOKA SURGERY CENTER, LLC | 201218596 - (FL) TOMOKA SURGERY CENTER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 42971 | $373.00 | 1891716767 - FEMI-CARE SURGERY CENTER, LLC | 710895222 - (MD) FEMICARE SURGERY CENTER LLC | MD | 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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