CPT 46942 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 | • 11 - Office • 22 - On Campus Outpatient Hospital |
| Common Modifiers | • None • 78 - Return to OR - related procedure • 79 - Unrelated procedure - postop period |
| Complexity Level | Moderate |
| CMS | $243.57 Physician Fee Schedule |
National average reimbursement for CPT 46942 by major payers:
$259.49
$287.49
$326.64
$393.66
| 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 46942 | ||||||
United | 46942 | $547.00 | 1275536393 - MEDICAL CENTER SURGERY ASSOCIATES, LP | 621449272 - (FL) MEDICAL CENTER SURGERY ASSOCIATES LP | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 46942 | $889.00 | 1194727883 - PROLIANCE SURGEONS, INC., P.S., PROLIANCE PUGET SOUND SURGERY CENTER | 911606533 - (WA) PROLIANCE SURGEONS, INC., P.S. | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 46942 | $287.00 | 1548254402 - LIVE OAK ENDOSCOPY CENTER, LLC | 10709517 - (FL) LIVE OAK ENDOSCOPY CENTER | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 46942 | $182.27 | 1790205862 - SHEA SOUDERS | 350593390 - DEACONESS HOSPITAL INC | IN | Certified Registered Nurse Anesthetist (367500000X) |
United | 46942 | $412.00 | 1417566217 - CLEARWAY SURGERY CENTER OF EASTON, LLC | 851826166 - (MD) CLEARWAY SURGERY CENTER OF EASTON LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 46942 | $620.00 | 1316970916 - SURGICAL SPECIALTY CENTER, LLC | 721418824 - (LA) SURGICAL SPECIALTY CENTER LLC | LA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 46942 | $666.00 | 1568420388 - GREAT LAKES SURGICAL CENTER LLC | 562350398 - (MI) GREAT LAKES SURGICAL CENTER LL | MI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 46942 | $416.00 | 1104833839 - ROCHESTER SURGERY CENTER, P.C. | 200510602 - (MI) ROCHESTER SURGERY CENTER PC | MI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 46942 | $1067.00 | 1578892600 - THE RYE AMBULATORY SURGERY CENTER, LLC | 262335845 - (NY) THE RYE AMBULATORY SURGERY CENTER LLC | NY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 46942 | $325.00 | 1376797332 - RENUE SURGERY CENTER LLC | 262423545 - (GA) RENUE SURGERY CENTER LLC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 46942 | $774.00 | 1457968430 - PARK VENTURA ENDOSCOPY CENTER, LLC, DIGESTIVE HEALTH CENTER OF ALLEN | 412059014 - (TX) PARK VENTURA ENDOSCOPY CENTER LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 46942 | $472.00 | 1235683798 - ASSOCIATED SURGICAL CENTER LLC | 813492018 - (IL) ASSOCIATED SURGICAL CENTER LLC | IL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 46942 | $541.00 | 1356488837 - RIDGEWOOD SURGERY AND ENDOSCOPY CENTER LLC | 204239587 - (KS) RIDGEWOOD SURGERY AND ENDOSCOPY CENTER, LLC | KS | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 46942 | $934.00 | 1285215301 - LAKEWOOD RANCH SURGICAL SUITES, LLC | 842624445 - (FL) LAKEWOOD RANCH SURGICAL SUITES LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 46942 | $330.00 | 1194987222 - ADVANCED SURGERY CENTER OF PALM BEACH COUNTY, LLC, ADVANCED SURGERY CENTER | 262830080 - (FL) ADVANCED SURGERY CENTER OF PALM BEACH COUNTY LLC | FL | 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 46942 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 46942 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 46942 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 |
|---|---|---|
| 46730-CPT | High | Construct Anus Perineal/Sacrococcyg |
| 46735-CPT | High | Construct Anus-Absnc;Abd/Perin Appc |
| 46930-CPT | Moderate | Destruction Of Internal Hemorrhoids By Thermal Energy Eg Infrared Coagulation Cautery Radiofrequency |
| 46942-CPT | Moderate | Curettage Or Cauterization Of Anal Fissure, Including Dilation Of Anal Sphincter (Separate Procedure); Subsequent |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 46942. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 46942 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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