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See a sample rate comparisonCPT 42999 Fee Schedule
Last Verified: October 2026
Healthcare providers use this code to document and receive reimbursement for visits that address high-level medical decision-making, often including multiple diagnoses or prescription management.
Unlisted Proc Pharynx Adenoids Or Tonsils, Unlisted Procedure Pharynx Adenoids Or Tonsils
| Key Fact | Detail |
|---|---|
| Service Type | Surgery Surgical Procedures on the Digestive System |
| Common Place of Service | 11 - Office 22 - On Campus Outpatient Hospital |
| Common Modifiers | UA UB |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 42999 |
| Medicaid Fee Schedule | $322.705 median of the 2 states in the free preview · View Medicaid rates for 42999 |
National average reimbursement for CPT 42999 by major payers:
$1,252.76
$65.50
$56.31
$643.47
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CPT 42999
5 of 25 sample ratesHigher to lower in this preview
El Dorado Surgery Center Lp, Tucson Endoscopy Center
$1,358.00Published rateProliance Surgery Center At Valley, LLC
Proliance Surgery Center At Valley LLC
$546.00Published rateAnne Arundel-Sca Surgicenter, LLC
Anne Arundelsca Surgicenter LLC
$214.00Published rateModesto Surgery Center LLC
$129.00Published rateThe Surgical Center Of Greater Annapolis, Inc.
The Surgical Center Of Greater Annapolis Inc
$76.00Published rate
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See a sample payer proposalCPT 42999 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 42999 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 42999 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 |
|---|---|---|
| 42699-CPT | Moderate | Unlisted Proc Salivary Gland Or Ducts, Unlisted Procedure Salivary Glands Or Ducts |
| 42835-CPT | Moderate | Adenoidectomy, Secondary; Under Age 12 |
| 42836-CPT | Moderate | Adenoidectomy Secondary 12 & Over |
| 42999-CPT | High | Unlisted Proc Pharynx Adenoids Or Tonsils, Unlisted Procedure Pharynx Adenoids Or Tonsils |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 42999. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 42999 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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