CPT 50542 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 Urinary System |
| Common Place of Service | • 22 - On Campus Outpatient Hospital • 21 - Inpatient Hospital |
| Common Modifiers | • None • LT - Left side of body • RT - Right side of body |
| Complexity Level | High |
| CMS | $1,128.25 Physician Fee Schedule |
National average reimbursement for CPT 50542 by major payers:
$1,577.91
$1,567.57
$1,589.89
$1,939.94
| 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 50542 | ||||||
United | 50542 | $8917.00 | 1720085277 - ROSWELL SURGERY CENTER LLC, ROSWELL SURGERY CENTER | 582577112 - (GA) ROSWELL SURGERY CENTER LLC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 50542 | $4500.00 | 1295848752 - ESSEX SURGICAL ARTS SURGERY CENTER, LLC, MOBILE VASCULAR PHYSICIANS | 202242123 - (NJ) ESSEX SURGICAL ARTS SURGERY | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 50542 | $3400.00 | 1972549491 - UNION CITY ASC LLC, SUMMIT ENDOSCOPY CENTER | 621625423 | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 50542 | $1100.00 | 1770076010 - BARNET DULANEY PERKINS EYE CENTER, PC, BDPEC ASC SAFFORD | 562589722 - BARNET DULANEY PERKINS EYE CENTER PLLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 50542 | $3941.00 | 1235551052 - LONG ISLAND DIGESTIVE ENDOSCOPY CENTER, LLC | 454714972 | NY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 50542 | $1232.00 | 1801094669 - CLEVELAND EYE AND LASER SURGERY CENTER LLC | 205487161 - (OH) CLEVELAND EYE & LASER SURGERY CENTER | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 50542 | $1445.00 | 1689059222 - GOLDSTEP AMBULATORY SURGERY CENTER, LLC | 465647464 - (NY) GOLDSTEP AMBULATORY SURGERY CENTER LLC | NY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 50542 | $10340.00 | 1487039517 - KC PAIN ASC, LLC | 464510621 - (MO) KC PAIN ASC LLC | MO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 50542 | $8917.00 | 1407275282 - SURGCENTER CAMELBACK LLC | 464169482 - (AZ) SURGCENTER CAMELBACK LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 50542 | $4170.00 | 1811095136 - GROSSMONT OUTPATIENT SURGICAL CENTER | 953337109 - (CA) GROSSMONT OUTPATIENT SURGICAL CE | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 50542 | $12291.00 | 1598096802 - MEMORIAL HERMANN SURGERY CENTER MEMORIAL CITY LLC, MEMORIAL HERMANN MEMORIAL VILLAGE SURGERY CENTER | 264276930 | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 50542 | $4024.00 | 1154326650 - SCOTTSDALE SURGICAL PARTNERS LLC, NORTH VALLEY SURGERY CENTER | 201808351 | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 50542 | $10000.00 | 1639701980 - ORTHOPAEDIC SURGERY CENTER OF PANTHER CREEK LLC | 843730735 - (NC) ORTHOPAEDIC SURGERY CENTER OF PANTHER CREEK LLC | NC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 50542 | $4903.00 | 1154481984 - SPRING VALLEY SURGERY CENTER, LLC | 880512805 - (NV) SPRING VALLEY SURGERY CENTER LLC | NV | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 50542 | $1251.00 | 1407247208 - COLONOSCOPY AND ENDOSCOPY CENTER LLC | 471628673 - (OH) COLONOSCOPY AND ENDOSCOPY CENTER LLC | OH | 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 50542 vs. Other Surgical Procedures on the Urinary System Codes
The CPT 50542 code is part of the Surgery services used for Surgical Procedures on the Urinary 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 50542 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 |
|---|---|---|
| 50541-CPT | High | Laparoscopy, Surgical; Ablation Of Renal Cysts |
| 50542-CPT | High | Laparoscopy, Surgical; Ablation Of Renal Mass Lesion(S), Including Intraoperative Ultrasound Guidance & Monitoring, When Performed- Rn Review>=6/10/2006 |
| 50543-CPT | High | Laparoscopy, Surgical; Partial Nephrectomy |
| 50545-CPT | High | Laparoscopy, Surgical; Radical Nephrectomy (Includes Removal Of Gerota S Fascia And Surrounding Fatty Tissue, Removal Of Regional Lymph Nodes, And Adrenalectomy) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 50542. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 50542 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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