CPT 47425 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 |
| Common Modifiers | • None • 51 - Multiple procedures • 80 - Assistant surgeon |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 47425 |
National average reimbursement for CPT 47425 by major payers:
$1,733.06
$1,809.68
$1,870.35
$2,213.12
| 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 47425 | ||||||
United | 47425 | $1061.00 | 1538276688 - MELVILLE SC LLC, MELVILLE SURGERY CENTER | 203487522 - (NY) MELVILLE SURGERY CENTER, LLC | NY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 47425 | $712.00 | 1306989249 - MEDICAL ARTS SURGERY CENTER LLC | 208261564 | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 47425 | $1353.00 | 1710321328 - VALLEY PHYSICIANS SURGERY CENTER AT NORTHRIDGE LLC | 800864336 - (CA) VALLEY PHYSICIANS SURGERY CENTER OF NORTHRIDGE LLC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 47425 | $1141.00 | 1073039657 - UNIVERSITY ORTHOPEDICS, INC., UOI-EAST BAY SURGERY CENTER | 873506992 | RI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 47425 | $266.00 | 1457465338 - METROPOLITAN AMBULATORY UROLOGIC INSTITUTE, L.L.C. | 522030624 - (MD) METROPOLITAN AMBULATORY UROLOGIC INSTITUTE LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 47425 | $883.00 | 1245346923 - AESTHETIC PLASTIC SURGERY INSTITUTE OF LOUISVILLE, LLC, LOUISVILLE SURGERY CENTER | 611464714 - (KY) AESTHETIC PLASTIC SURGERY INSTITUTE | KY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 47425 | $675.00 | 1750521720 - SPOKANE VALLEY EAR NOSE & THROAT PS, SPOKANE VALLEY AMBULATORY SURGERY CENTER | 911072626 - (WA) SPOKANE VALLEY EAR, NOSE & THROAT, P.S. | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 47425 | $656.00 | 1285870303 - LAPORTE MEDICAL GROUP SURGICAL CENTER, LLC | 260505795 - (IN) LAPORTE MEDICAL GROUP SURGICAL CENTER LLC | IN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 47425 | $200.00 | 1487699385 - MWGI LLC, BRANDYWINE VALLEY ENDOSCOPY CENTER | 593788546 - (PA) MWGI LLC | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 47425 | $1420.00 | 1366406233 - MIDDLE TENNESSEE AMBULATORY SURGERY CENTER, L.P. | 621699667 - (TN) MIDDLE TENNESSEE AMBULATORY SURGERY CENTER LP | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 47425 | $309.00 | 1366032617 - EMERSON ENDOSCOPY AND DIGESTIVE HEALTH CENTER, LLC | 843673604 - (MA) EMERSON ENDOSCOPY AND DIGESTIVE HEALTH CENTER LLC | MA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 47425 | $1049.00 | 1871751859 - WESTMINSTER SURGERY CENTER | 262059600 - (MD) WESTMINSTER SURGERY CENTER LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 47425 | $840.00 | 1689133290 - MOHAWK SURGERY CENTER LLC | 830632231 - (FL) MOHAWK SURGERY CENTER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 47425 | $990.00 | 1366761397 - MEDINA-SUMMIT AMBULATORY SURGERY CENTER, THE MEDINA SURGERY CENTER | 261421110 - (OH) SUMMA HEALTH, PENSION ADMINISTATION COMMITTEE | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 47425 | $569.00 | 1154481984 - SPRING VALLEY SURGERY CENTER, LLC | 880512805 - (NV) SPRING VALLEY SURGERY CENTER LLC | NV | 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 47425 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 47425 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 47425 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 |
|---|---|---|
| 47400-CPT | High | Hepaticotomy/Ostomy |
| 47420-CPT | High | Choledochotomy Or Choledochostomy With Exploration, Drainage, Or Removal Of Calculus, With Or Without Cholecystotomy; Without Transduodenal Sphincterotomy Or Sphincteroplasty |
| 47425-CPT | High | Choledochotomy Or Choledochostomy With Exploration, Drainage, Or Removal Of Calculus, With Or Without Cholecystotomy; With Transduodenal Sphincterotomy Or Sphincteroplasty |
| 47562-CPT | Moderate | Laparoscopy; Cholecystectomy |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 47425. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 47425 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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