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 |
| CMS | $2,447.98 Physician Fee Schedule |
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 | $1055.69 | 1417944778 - MERRIMACK VALLEY ENDOSCOPY CENTER | 43578297 - (MA) MERRIMACK VALLEY ENDOSCOPY CENTER | MA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 46742 | $523.00 | 1215275227 - ISPM ASC AT PIEDMONT, LLC | 455109249 - (GA) ISPM ASC AT PIEDMONT LLC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 46742 | $1028.00 | 1588610190 - SUMMIT AMBULATORY SURGICAL CENTER, LLC | 522148280 | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 46742 | $328.00 | 1164404638 - CAMPUS EYE GROUP ASC INC, SURGICENTER ANESTHESIA ASSOCIATES | 223047283 | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 46742 | $552.00 | 1174502272 - ENDOSCOPY CENTER OF TOPEKA LP, THE ENDOSCOPY AND SURGERY CENTER OF TOPEKA | 621512368 - (KS) THE ENDOSCOPY CENTER OF TOPEKA L | KS | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 46742 | $280.00 | 1275836645 - BROOKSTONE AMBULATORY SURGERY CENTER | 263097292 - (GA) BROOKSTONE AMBULATORY SURGERY CENTER | GA | 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 | $445.00 | 1114907920 - MIAMI ASC LP, THE ENDOSCOPY CENTER | 621600424 - (FL) MIAMI ASC LP | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 46742 | $310.00 | 1841395621 - BERKELEY ENDOSCOPY CENTER LLC | 383712079 - (SC) BERKELEY ENDOSCOPY CENTER LLC | SC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 46742 | $750.00 | 1972232981 - SOUTHPOINT SURGERY CENTER LLC | 841989776 - (NC) SOUTHPOINT SURGERY CENTER LLC | NC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 46742 | $1049.00 | 1740794973 - EPIC ASC, LLC, EPIC SURGERY CENTER | 611859657 | KS | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 46742 | $441.00 | 1639452444 - CHILDREN'S AMBULATORY SURGERY CENTER OF NEW JERSEY, LLC | 271462884 - (NJ) CHILDRENS AMBULATORY SURGERY CENTER OF NEW JERSEY LLC | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 46742 | $4949.00 | 1538179551 - HENRY FORD MEDICAL CENTER FAIRLANE, HENRY FORD HEALTH SYSTEM | 381357020 - HENRY FORD HEALTH SYSTEM | MI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 46742 | $351.00 | 1225050347 - STATE HILL SURGICENTER LLC | 203106650 | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 46742 | $281.00 | 1619065273 - SHENANDOAH TX ENDOSCOPY ASC LLC, WOODLANDS ENDOSCOPY CENTER | 205301383 | TX | 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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