CPT 47542 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 | • 22 - On Campus Outpatient Hospital • 21 - Inpatient Hospital |
| Common Modifiers | • None • GC - Service performed by resident under supervision • 59 - Distinct Procedural Service |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 47542 |
National average reimbursement for CPT 47542 by major payers:
$558.59
$690.79
$709.11
$808.91
| 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 47542 | ||||||
United | 47542 | $320.04 | 1982631545 - BRUCE STEIN | 270105141 - (NY) FLORAL PARK ARTHRITIS PC | NY | Rheumatology Physician (207RR0500X) |
United | 47542 | $744.77 | 1396270310 - JESSICA ORTEGA | 541383504 - TOWN CENTER ORTHOPAEDIC ASSOCIATES, P.C. | VA | Medical Physician Assistant (363AM0700X) |
United | 47542 | $184.78 | 1285350918 - ERIN KELLY | 541383504 - TOWN CENTER ORTHOPAEDIC ASSOCIATES, P.C. | VA | Occupational Therapist (225X00000X) |
United | 47542 | $658.92 | 1447598677 - MAKOTO TOKIWA | 135598093 - COLUMBIA UNIVERSITY IN THE CITY OF NEW YORK | NY | Obstetrics & Gynecology Physician (207V00000X) |
United | 47542 | $1510.71 | 1306853205 - PETER GREEN | 135598093 - COLUMBIA UNIVERSITY IN THE CITY OF NEW YORK | NY | Gastroenterology Physician (207RG0100X) |
United | 47542 | $3322.32 | 1457617771 - WUNGKI PARK | 133278578 - (NY) WESTCHESTER MEDICAL CENTER ADVANCED PHYSICIAN SERVICES PC | NY | Medical Oncology Physician (207RX0202X) |
United | 47542 | $658.92 | 1396372868 - NICHOLAS MOORE | 135598093 - COLUMBIA UNIVERSITY IN THE CITY OF NEW YORK | NY | Pediatrics Physician (208000000X) |
United | 47542 | $394.80 | 1568609378 - JEREMY LEE | 350593390 - DEACONESS HOSPITAL INC | SC | Certified Registered Nurse Anesthetist (367500000X) |
United | 47542 | $453.39 | 1982631545 - BRUCE STEIN | 270105141 - (NY) FLORAL PARK ARTHRITIS PC | NY | Rheumatology Physician (207RR0500X) |
United | 47542 | $1252.58 | 1659388858 - LISA JORDAN-SCALIA | 223741339 - (NJ) RARITAN FAMILY HEALTHCARE PA | NJ | Family Medicine Physician (207Q00000X) |
United | 47542 | $744.77 | 1487755955 - TOWN CENTER ORTHOPAEDIC ASSOCIATES, P.C. | 541383504 - TOWN CENTER ORTHOPAEDIC ASSOCIATES, P.C. | VA | Orthopaedic Surgery Physician (207X00000X) |
United | 47542 | $682.35 | 1255478004 - CHRISTOPHER RAIO | 113438973 - ST JOSEPH HOSPITAL | NY | Emergency Medicine Physician (207P00000X) |
United | 47542 | $2475.58 | 1730766197 - ZOHAIB SHAIKH | 133278578 - (NY) WESTCHESTER MEDICAL CENTER ADVANCED PHYSICIAN SERVICES PC | NY | Internal Medicine Physician (207R00000X) |
United | 47542 | $2772.91 | 1457617771 - WUNGKI PARK | 133278578 - (NY) WESTCHESTER MEDICAL CENTER ADVANCED PHYSICIAN SERVICES PC | NY | Medical Oncology Physician (207RX0202X) |
United | 47542 | $707.60 | 1447598677 - MAKOTO TOKIWA | 135598093 - COLUMBIA UNIVERSITY IN THE CITY OF NEW YORK | NY | Obstetrics & Gynecology Physician (207V00000X) |
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 47542 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 47542 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 47542 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 |
|---|---|---|
| 47538-CPT | High | Placement Of Stent(S) Into A Bile Duct Percutaneous Including Diagnostic Cholangiography Imaging Guidance (Eg Fluoroscopyand/Or Ultrasound) Balloon Dilation Catheter Exchange(S) And Catheter Removal(S) When Performed And All Associated Radiological Supervision And Interpretation; Existing Access. (Desc Revised 1/1/2017) |
| 47539-CPT | High | Placement Of Stent(S) Into A Bile Duct Percutaneous Including Diagnostic Cholangiographyimaging Guidance (Eg Fluoroscopy And/Or Ultrasound) Balloon Dilation Catheter Exchange Or Removal When Performed And All Associated Radiological Supervision And Interpretation Each Stent; New Access Without Placement Of Separate Biliary Drainage Catheter. |
| 47540-CPT | High | Placement Of Stent(S) Into A Bile Duct Percutaneous Including Diagnostic Cholangiographyimaging Guidance (Eg Fluoroscopy And/Or Ultrasound) Balloon Dilation Catheter Exchange Or Removal When Performed And All Associated Radiological Supervision And Interpretation Each Stent; New Access With Placement Of Separate Biliary Drainage Catheter (Eg External Or Internal-External). |
| 47542-CPT | Moderate | Balloon Dilation Of Biliary Duct(S) Or Of Ampulla (Sphincteroplasty) Percutaneous Including Imaging Guidance (Eg Fluoroscopy) And All Associated Radiological Supervision And Interpretation Each Duct (List Separately In Addition To Code For Primary Procedure). |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 47542. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 47542 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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