CPT 42975 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 • 24 - Ambulatory Surgical Center |
| Common Modifiers | • None • 51 - Multiple procedures • SG - Scene to Hospital ESRD facility |
| Complexity Level | Low |
| CMS | $94.45 Physician Fee Schedule |
National average reimbursement for CPT 42975 by major payers:
$132.99
$157.50
$151.08
$190.19
| 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 42975 | ||||||
United | 42975 | $1446.00 | 1639146541 - CENTENNIAL ASC, LLC, BAYLOR SURGICARE AT CENTENNIAL | 352199232 - (TX) CENTENNIAL ASC LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 42975 | $633.00 | 1740673953 - MANCHESTER AMBULATORY SURGERY CENTER LP, DES PERES SQUARE SURGERY CENTER | 205953313 | MO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 42975 | $855.00 | 1477503175 - PALMS WEST SURGERY CENTER LTD | 201008459 - (FL) PALMS WEST SURGERY CENTER LTD | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 42975 | $555.00 | 1659748184 - SURGCENTER OF THE POTOMAC, LLC | 472311914 - (MD) SURGCENTER OF THE POTOMAC, LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 42975 | $144.00 | 1336658145 - BROWN UROLOGY, INC., COLLYER STREET OPERATORY | 821512459 - (RI) BROWN UROLOGY INC | RI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 42975 | $554.00 | 1922234855 - EYE SURGERY CENTER OF GEORGIA, LLC | 262852432 - (GA) EYE SURGERY CENTER OF GEORGIA LLC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 42975 | $1343.00 | 1962435990 - NORTHERN MONMOUTH REGIONAL SURGERY CENTER LLC, CENTER FOR BONE AND JOINT SURGERY | 201026094 - (NJ) NORTHERN MONMOUTH REGIONAL SURGERY CENTER LLC | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 42975 | $200.00 | 1497367262 - SNKS ENTERPRISES LLC, SOL VALLEY SURGERY CENTER | 364932587 - (AZ) SNKS ENTERPRISES LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 42975 | $123.00 | 1851678981 - RIDGECREST SPECIALTY SURGERY CENTER, A PROFESSIONAL CORPORATION | 453602999 - (CA) RIDGECREST SPECIALTY SURGERY CENTER A PROFESSIONAL CORPORATION | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 42975 | $218.00 | 1215061049 - PRESBYTERIAN SAMEDAY SURGERY CENTER AT BALLANTYNE LLC, NOVANT HEALTH BALLANTYNE OUTPATIENT SURGERY | 203135052 | NC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 42975 | $312.00 | 1912174996 - PACIFIC CATARACT AND LASER INSTITUTE INC PC | 911394965 - PACIFIC CATARACT AND LASER INSTITUTE, INC., PC | MT | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 42975 | $601.00 | 1770513855 - CAPITAL ENDOSCOPY LLC | 134244093 - (MD) CAPITAL ENDOSCOPY & SURGERY CENTER | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 42975 | $326.00 | 1538231956 - COASTAL MEDICAL CENTER LLC | 650956639 - (FL) COASTAL MEDICAL CENTER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 42975 | $125.00 | 1346808714 - VANCE THOMPSON VISION SURGERY CENTER ALEXANDRIA, LLC | 364907311 - VANCE THOMPSON VISION SURGERY CENTER ALEXANDRIA LLC | MN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 42975 | $1708.00 | 1801974720 - SUMMIT SURGICAL CENTER, LLC | 731730859 | NJ | 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 42975 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 42975 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 42975 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 |
|---|---|---|
| 42953-CPT | High | Repair Pharyngoesophageal |
| 42960-CPT | Moderate | Control Hemorrhage Oropharynx Simp |
| 42961-CPT | Moderate | Control Oropharyngeal Hemorrhage (Primary Or Secondary, Eg, Posttonsillectomy); Complicated, Requiring Hospitalization |
| 42975-CPT | Low | Drug-Induced Sleep Endoscopy, With Dynamic Evaluation Of Velum, Pharynx, Tongue Base, And Larynx For Evaluation Of Sleep-Disordered Breathing, Flexible, Diagnostic |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 42975. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 42975 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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