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 |
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 | $6588.00 | 1366559122 - HARVARD PARK SURGERY CENTER, LLC, HARVARD PARK SURGERY CENTER | 331107194 - (CO) HARVARD PARK SURGERY CENTER LLC | CO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 58542 | $4350.00 | 1316936016 - WESTLAKE SPINE & OUTPATIENT SURGERY CENTER | 204997865 - (CA) JOURNEY LITE OF THE CENTRAL COAST LLC | CA | 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 | $5654.00 | 1316072234 - ARIA HEALTH SYSTEM, ARIA HEALTH FRANKFORD CAMPUS SPU | 230596940 - (PA) JEFFERSON HEALTH-NORTHEAST | 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 | $1099.00 | 1114312659 - UNITED SHOCKWAVE SERVICES, LTD., UNITED THERAPIES | 363415474 | IL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 58542 | $3251.00 | 1396203238 - SUN CITY CENTER AMBULATORY SURGERY CENTER, LLC, SUN CITY ASC | 832043435 - (FL) SUN CITY CENTER AMBULATORY SURGERY CENTER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 58542 | $5750.00 | 1689133290 - MOHAWK SURGERY CENTER LLC | 830632231 - (FL) MOHAWK SURGERY CENTER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 58542 | $2201.00 | 1720041536 - CENTER FOR AMBULATORY SURGERY LLC | 161553086 - (NY) CENTER FOR AMBULATORY SURGERY, L.L.C. | NY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 58542 | $3275.00 | 1881125870 - RENAL ASSOCIATES, P.A. | 742083988 - (TX) RENAL ASSOCIATES, PA | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 58542 | $3630.22 | 1417944778 - MERRIMACK VALLEY ENDOSCOPY CENTER | 43578297 - (MA) MERRIMACK VALLEY ENDOSCOPY CENTER | MA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 58542 | $2992.00 | 1366422370 - URLOGY AMBULATORY SURGERY CENTER LLC, WOLF RIVER SURGERY CENTER | 621828958 - (TN) URLOGY AMBULATORY SURGERY CENTER LLC | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 58542 | $10249.00 | 1982871935 - NORTHERN VIRGINIA SURGERY CENTER LLC | 203502477 - (VA) NORTHERN VIRGINIA SURGERY CENTER LLC | VA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 58542 | $4049.00 | 1275951196 - TEMECULA CA UNITED SURGERY CENTER, LP | 464144489 - (CA) TEMECULA CA UNITED SURGERY CEN | CA | 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 | 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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