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 |
| Medicare Fee Schedule | View Medicare rates for 42975 |
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 | $1306.00 | 1114965803 - ADVANCED ENDOSCOPY & SURGICAL CENTER LLC, ADVANCED ENDOSCOPY & SURGICAL CENTER | 113660090 - (NJ) ADVANCED ENDOSCOPY SURGICAL CENTER LLC | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 42975 | $225.00 | 1952852345 - HUEBNER AMBULATORY SURGERY CENTER, LLC | 813360799 - (TX) HUEBNER AMBULATORY SURGERY CENTER LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 42975 | $200.00 | 1316326242 - ST. MINA INTERVENTIONAL PAIN CENTER, INC, MINA PAIN CENTER | 473803677 - (OH) ST MINA INTERVENTIONAL PAIN CENTER INC | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 42975 | $305.00 | 1558327213 - SURGICARE OF JACKSON LTD | 752162993 - (MS) SURGICARE OF JACKSON LTD | MS | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 42975 | $529.00 | 1750505756 - SJ MEDICAL CENTER, LLC | 204835578 - (TX) SJ MEDICAL CENTER, LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 42975 | $118.00 | 1295948339 - WILMINGTON GASTROENTEROLOGY ENDOSCOPY CENTER, INC | 463956703 - (NC) WILMINGTON GASTROENTEROLOGY ENDOSCOPY CENTER INC | NC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 42975 | $574.00 | 1598083594 - MID-STATE ENDOSCOPY CENTER LLC | 270673692 - (TN) MIDSTATE ENDOSCOPY CENTER LLC | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 42975 | $555.00 | 1861071250 - ADVENTHEALTH SURGERY CENTER MILLS PARK LLC, ADVENTHEALTH SURGERY CENTER MILLS PARK | 832780608 - (FL) ADVENTHEALTH SURGERY CENTER MILLS PARK LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 42975 | $79.00 | 1518916758 - MOUNTAIN LAUREL SURGERY CENTER L.L.C. | 753187461 - (PA) MOUNTAIN LAUREL SURGERY CENTER, LLC | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 42975 | $90.00 | 1477507168 - LAKESIDE SURGERY LLC, LAKESIDE SURGERY CENTER | 752714441 - LAKESIDE SURGERY CENTER, LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 42975 | $252.00 | 1588638688 - MASONICARE HEALTH CENTER | 60655131 - (CT) MASONICARE HEALTH CENTER | CT | 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 | $1304.00 | 1710114293 - RIVERVIEW SURGERY CENTER AT THE NAVY YARD LP | 263910345 - (PA) RIVERVIEW SURGERY CENTER AT THE NAVY YARD LP | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 42975 | $410.00 | 1972578771 - SUN CITY AZ ENDOSCOPY ASC LLC, SUN CITY ENDOSCOPY CENTER | 201519369 - (AZ) SUN CITY AZ ENDOSCOPY ASC LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 42975 | $574.00 | 1558879684 - DELAWARE RIVER SURGICAL SUITES, LLC | 822713553 - (PA) BUCKS COUNTY SURGICAL SUITES | PA | 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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