CPT 46742 Fee Schedule
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.
| Key Fact | Detail |
|---|---|
| Service Type | • Surgery • Surgical Procedures on the Digestive System |
| Common Place of Service | • 21 - Inpatient Hospital • 22 - On Campus Outpatient Hospital • 11 - Office |
| Common Modifiers | • None • 82 - Assistant surgeon - no qualified resident • 62 - Co-Surgeons • 80 - Assistant surgeon |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 46742 |
National average reimbursement for CPT 46742 by major payers:
$3,085.65
$3,282.10
$3,408.79
$4,032.44
| 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 46742 | ||||||
United | 46742 | $1836.00 | 1881129351 - OCONTO HOSPITAL & MEDICAL CENTER, INC., BELLIN HEALTH MARINETTE SURGERY CENTER | 61745397 - OCONTO HOSPITAL & MEDICAL CENTER INC | WI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 46742 | $1028.00 | 1588610190 - SUMMIT AMBULATORY SURGICAL CENTER, LLC | 522148280 | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 46742 | $1347.00 | 1750517561 - CANON CITY CO MULTI SPECIALTY ASC LLC, ARKANSAS VALLEY SURGERY CENTER | 264730485 - (CO) CANON CITY CO MULTI SPECIALTY ASC LLC | CO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 46742 | $1043.00 | 1245288257 - SURGICAL CENTER OF GREENSBORO, LLC | 631251243 - (NC) SURGICAL CENTER OF GREENSBORO LLC | NC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 46742 | $442.00 | 1346416690 - GARDEN STATE AMBULATORY SURGERY CENTER PC | 223504597 - (NJ) GARDEN STATE AMBULATORY SURGERY CENTER PC | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 46742 | $72.00 | 1043367196 - SURGICAL SPECIALISTS GROUP, LLC, ALABAMA OUTPATIENT SURGERY CENTER | 201398879 - (AL) SURGICAL SPECIALISTS GROUP, LLC | AL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 46742 | $1800.00 | 1164458634 - SAINT FRANCIS SURGERY CENTER, LLC, SAINT FRANCIS SURGERY CENTER | 61641562 - (TN) SAINT FRANCIS SURGERY CENTER LLC | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 46742 | $1028.00 | 1114196151 - SUMMIT AMBULATORY SURGICAL CENTER LLC | 522148280 | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 46742 | $2302.00 | 1922160357 - ARAPAHOE ENDOSCOPY CENTER PARTNERSHIP PLLP | 472388780 | CO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 46742 | $983.00 | 1922510643 - OPTIMUM SPINE CENTER, LLC, PEACHTREE SPINE & PAIN PHYSICIANS | 320543789 | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 46742 | $413.00 | 1982074001 - CLINICAL ASSOCIATES P A, CLINICAL ASSOCIATES, ASC | 465765243 - (MD) CLINICAL ASSOCIATES, P.A. | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 46742 | $780.00 | 1033271176 - HALLMARK SURGICAL CENTER OF NORTHRIDGE | 954683164 - (CA) NORTHRIDGE SURGERY AND PAIN MANAGEMENT CENTER, INC. | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 46742 | $570.00 | 1891770814 - REGIONAL HAND CENTER OF CENTRAL CALIFORNIA, INC | 770521088 | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 46742 | $3451.00 | 1497244149 - HOSPITAL FOR SPECIAL SURGERY WEST SIDE AMBULATORY SURGERY CENTER, LLC, HSS WEST SIDE ASC, LLC | 814351390 | NY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 46742 | $670.00 | 1609896539 - CEDAR HILLS AMBULATORY SURGERY CENTER LLC, CEDAR HILLS SURGERY CENTER | 680580628 - (OR) CEDAR HILLS AMBULATORY SURGERY CENTER LLC | OR | 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 46742 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 46742 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 46742 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 |
|---|---|---|
| 46740-CPT | High | Repair Of Absence Of Opening In Anus And Abnormal Opening From Rectum Into Urethra Or Vagina Through Region Between Thighs Or Below Sacrum |
| 46742-CPT | High | Repair Of High Imperforate Anus With Recto-Urethral Or Recto-Vaginal Fistula; Combined Trans-Abdominal & Sacro-Perineal Approaches |
| 46746-CPT | High | Repair Of Defect For Single Channel Outlet Of Rectum, Vagina, And Urinary Tract Through Abdomen And Region Between Thighs Or Below Sacrum |
| 46924-CPT | Moderate | Destruction Of Lesion(S), Anus (Eg, Condyloma, Papilloma, Molluscum Contagiosum, Herpetic Vesicle), Extensive (Eg, Laser Surgery, Electrosurgery, Cryosurgery, Chemosurgery) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 46742. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 46742 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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