Rate Benchmarking
Compare your rates with similar providers.
Select a published rate, define comparable providers, and see where that rate falls in your market.
See a sample rate comparisonCPT 46742 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.
Epair Of Imperforated Anus, Repair Of Absence Of Opening In Anus And Abnormal Opening From Rectum Into Urethra Or Vagina Approached Through Abdomen Or Below Sacrum (Combined Abdominal And Sacroperineal Approach)
| 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 |
| Medicaid Fee Schedule | View Medicaid rates for 46742 |
National average reimbursement for CPT 46742 by major payers:
$3,085.65
$3,282.10
$3,408.79
$3,943.35
Compare published rates across providers.
Choose a payer to see a sample of rates for CPT 46742.
CPT 46742
5 of 25 sample ratesHigher to lower in this preview
Hospital For Special Surgery West Side Ambulatory Surgery Center, LLC, Hss West Side Asc, LLC
$3,451.00Published rateSurgical Center Of Greensboro, LLC
Surgical Center Of Greensboro LLC
$1,043.00Published rateCedar Hills Ambulatory Surgery Center LLC, Cedar Hills Surgery Center
Cedar Hills Ambulatory Surgery Center LLC
$670.00Published rateChildren'S Ambulatory Surgery Center Of New Jersey, LLC
Childrens Ambulatory Surgery Center Of New Jersey LLC
$441.00Published rateSurgical Specialists Group, LLC, Alabama Outpatient Surgery Center
Surgical Specialists Group, LLC
$72.00Published rate
Get a free rate benchmark for your specialty.
Choose your state and specialty to build a report from payer-published rates.
Use market rates to prepare your payer proposal.
Payer Contract Negotiation
Draft a fee schedule renegotiation letter.
Use your fee schedule and market benchmarks to set target rates and draft a letter for your payer.
See a sample payer proposalCPT 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 | Construction Of Absent Anus, Repair Of Absence Of Opening In Anus And Abnormal Opening From Rectum Into Urethra Or Vagina Approached Through Region Between Thighs Or Below Sacrum (Perineal Or Sacroperineal Approach) |
| 46742-CPT | High | Epair Of Imperforated Anus, Repair Of Absence Of Opening In Anus And Abnormal Opening From Rectum Into Urethra Or Vagina Approached Through Abdomen Or Below Sacrum (Combined Abdominal And Sacroperineal Approach) |
| 46746-CPT | High | Repair Of Cloacal Anomaly, Repair Of Defect For Single Channel Outlet Of Rectum Vagina And Urinary Tract Via Incision Of Region Between Thighs Or Below Sacrum (Combined Abdominal And Sacroperineal Approach) |
| 46924-CPT | Moderate | Destruction Anal Lesion S, 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.
FREE SAMPLE MARKET COMPARISON
Let's review your payer contracts side-by-side with the market.
Bring your top codes (like CPT 46742) and we'll show you how you compare in 15 minutes or less.