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See a sample rate comparisonCPT 42975 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.
Dise Eval Slp Do Brth Flx Dx, Drug Induced Sleep Endoscopy With Dynamic Evaluation Of Velum Pharynx Tongue Base And Larynx For Evaluation Of Sleep Disordered Breathing Flexible Diagnostic
| 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 | 51 - Multiple procedures SG - Scene to Hospital ESRD facility |
| Complexity Level | Low |
| Medicare Fee Schedule | $83.50 national non-facility rate (2026) · View Medicare rates for 42975 |
| Medicaid Fee Schedule | $70.52 median of the 8 states in the free preview · View Medicaid rates for 42975 |
National average reimbursement for CPT 42975 by major payers:
$132.99
$157.50
$151.08
$188.75
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CPT 42975
5 of 25 sample ratesHigher to lower in this preview
Advanced Endoscopy & Surgical Center LLC, Advanced Endoscopy & Surgical Center
Advanced Endoscopy Surgical Center LLC
$1,306.00Published rateMetropolitan Medical Partners LLC, Surgery Center Of Chevy Chase
Metropolitan Medical Partners Ll
$574.00Published rateMasonicare Health Center
$252.00Published rateNacogdoches County Hospital District, Nacogdoches Memorial Hospital Day Surg Cidc
Lion Star Nacogdoches Hospital, LLC Dba Nacogdoches Memorial Hospital
$189.00Published rateSoutheast Eye Surgery Center, LLC
Southeast Eye Surgery Center LLC
$59.00Published rate
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Payer Contract Negotiation
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See a sample payer proposalCPT 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 Oropharyngeal Hemorrha, Control Oropharyngeal Hemorrhage Primary Or Secondary (Eg Posttonsillectomy) Simple Control Oropharyngeal Hemorrhage Primary Or Secondary (Eg |
| 42961-CPT | Moderate | Control Oropharyngeal Hemorrha, Control Oropharyngeal Hemorrhage Primary Or Secondary (Eg Posttonsillectomy) Complicated Requiring Hospitalization Control Oropharyngeal Hemorrhage Primary Or Secondary (Eg |
| 42975-CPT | Low | Dise Eval Slp Do Brth Flx Dx, 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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Frequently Asked Questions
To find the cost of a medical procedure or service beforehand, you can start by contacting your insurance provider. They can give you an estimate of what will be covered and what your out-of-pocket costs might be. For a more direct way to look up specific prices based on CPT codes and your location, you can use online tools. Payerprice offers a fee schedule lookup tool that allows users to search with a CPT code and specific location to get an idea of potential costs in your area.
CPT stands for Current Procedural Terminology. CPT codes are standardized numerical codes used by healthcare providers to describe medical, surgical, and diagnostic services to entities such as physicians, hospitals, and health insurance companies. Each service you receive, from a simple office visit to a complex surgery, has a specific CPT code. These codes are crucial because they determine how providers bill for services and how insurance companies process claims. Understanding the CPT code for a service can help you research its cost and compare prices, for instance, by using tools like Payerprice.
Healthcare prices can vary significantly for the same medical service due to several factors. These include the specific insurance plan's negotiated rates with providers, the type of facility (e.g., hospital vs. outpatient clinic), the geographic location, the provider's specialization and reputation, and the complexity of the patient's individual case. Additionally, charges can differ based on whether a provider is in-network or out-of-network with your insurance. Tools like Payerprice can help you see this variation and compare prices in your specific location.
If you receive a medical bill that seems too high or unexpected, the first step is to carefully review the itemized bill for any errors or services you did not receive. Then, contact the billing department of the healthcare provider to request an explanation and clarify any charges. Simultaneously, contact your insurance company to understand what was covered and why certain amounts were or were not paid. If you want to verify the typical cost of the services listed on your bill, you can use Payerprice's fee schedule lookup tool with the CPT codes to compare it against local averages.
To compare prices for healthcare services in your specific area, you should utilize available transparency tools. Payerprice offers a fee schedule lookup tool designed precisely for this purpose. By entering the CPT code for the service you need and your specific location, you can search and see a range of costs, helping you make a more informed decision about where to receive care and what to expect financially.