CPT 58542 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 Female Genital System |
| Common Place of Service | • 22 - On Campus Outpatient Hospital • 21 - Inpatient Hospital |
| Common Modifiers | • None • 51 - Multiple procedures • 80 - Assistant surgeon |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 58542 |
National average reimbursement for CPT 58542 by major payers:
$1,062.82
$1,159.15
$1,205.90
$1,429.77
| 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 58542 | ||||||
United | 58542 | $2875.00 | 1851356786 - WAUSAU SURGERY CENTER LLC | 621525773 - (WI) WAUSAU SURGERY CENTER, L.P. | WI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 58542 | $1908.00 | 1043208283 - TRACEY A. SCHMUCKER, M.D., P.A., LOWERY SURGERY CENTER | 262165143 - (AR) TRACEY A SCHMUCKER MD PA | AR | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 58542 | $2172.00 | 1902876212 - SCAC LLC, SURGERY CENTER AT CRANBERRY | 562286973 - (PA) SCAC LLC | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 58542 | $5750.00 | 1619935483 - OUTPATIENT SURGERY CENTER OF HILTON HEAD | 611409045 - (SC) OUTPATIENT SURGERY CENTER OF HILTON HEAD | SC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 58542 | $1442.28 | 1629018189 - YO-HANG ONG | 350593390 - DEACONESS HOSPITAL INC | CA | Anesthesiology Physician (207L00000X) |
United | 58542 | $7254.00 | 1285912600 - THE EMORY CLINIC INC, THE EMORY CLINIC LAGRANGE SURGERY CENTER | 582030692 - EMORY UNIVERSITY | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 58542 | $5750.00 | 1912900143 - E STREET ENDOSCOPY LLC, WEST COAST ENDOSCOPY | 593705426 - (FL) E STREET ENDOSCOPY | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 58542 | $1796.00 | 1295897106 - WESTMONT SURGERY CENTER LLC, SALT CREEK SURGERY CENTER | 364419691 - WESTMONT SURGERY CENTER, LLC DBA SALT CREEK SURGERY CENTER | IL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 58542 | $3302.00 | 1871174706 - AMBULATORY CARDIOVASCULAR CENTER OF MISSISSIPPI | 861979907 - (MS) AMBULATORY CARDIOVASCULAR CENTER OF MISSISSIPPI | MS | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 58542 | $1897.00 | 1710931134 - NOVAMED SURGERY CENTER OF JONESBORO, LLC, EYE SURGERY CENTER OF ARKANSAS | 204407053 - (AR) NOVAMED SURGERY CENTER OF JONESBORO LLC | AR | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 58542 | $2460.00 | 1720606932 - PHYSICIANS CLINIC INC | 470687317 - PHYSICIANS CLINIC INC | NE | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 58542 | $3275.00 | 1003478744 - ACHY LEGS CLINICS LLC, CENTER FOR CARDIOVASCULAR EXCELLENCE | 820799709 - (TX) ACHY LEGS CLINICS LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 58542 | $3762.00 | 1972055382 - ALLIANCE SURGERY PARTNERS, LLC | 901108673 - (CA) ALLIANCE SURGERY PARTNERS LLC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 58542 | $3670.00 | 1457370447 - ORTHOPEDIC ASSOCIATES SURGERY CENTER LLC | 200446252 - (CT) ORTHOPEDIC ASSOCIATES SURGERY CENTER LLC | CT | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 58542 | $4100.00 | 1386161495 - MEDSTAR SURGERY CENTER AT BRANDYWINE, LLC | 820985178 - (MD) MEDSTAR SURGERY CENTER AT BRAN | MD | 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 58542 vs. Other Surgical Procedures on the Female Genital System Codes
The CPT 58542 code is part of the Surgery services used for Surgical Procedures on the Female Genital 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 58542 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 |
|---|---|---|
| 58180-CPT | High | Supracervical Abdominal Hysterectomy (Subtotal Hysterectomy), With Or Without Removal Of Tube(S), With Or Without Removal Of Ovary(S) |
| 58280-CPT | High | Removal Of Uterus And Vagina With Repair Of Herniated Bowel Into Rectum Or Vagina Through Vagina |
| 58346-CPT | Moderate | Insertion Of Heyman Capsules For Clinical Brachytherapy |
| 58542-CPT | High | Laparoscopy, Surgical, Supracervical Hysterectomy, For Uterus 250 G Or Less; With Removal Of Tube(S) And/Or Ovary(S) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 58542. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 58542 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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