CPT 63042 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 Nervous System |
| Common Place of Service | • 21 - Inpatient Hospital • 22 - On Campus Outpatient Hospital |
| Common Modifiers | • None • AS - PA/NP/CNS assistant at surgery • LT - Left side of body |
| Complexity Level | High |
National average reimbursement for CPT 63042 by major payers:
$1,796.57
$1,789.45
$1,906.96
$2,178.26
| 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 63042 | ||||||
United | 63042 | $2684.00 | 1356463913 - MODESTO SURGERY CENTER LLC | 770394007 | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 63042 | $3535.00 | 1902850571 - SDM ASC LLC, DAYTIME OUTPATIENT SURGERY CENTER | 752816595 - (TX) SDM ASC LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 63042 | $8163.00 | 1033351119 - SSM ST CLARE SURGICAL CENTER LLC, SSM ST CLARE SURGICAL CENTER | 261439695 - (MO) SSM ST CLARE SURGICAL CENTER LLC | MO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 63042 | $3700.00 | 1699286922 - HUMBLE VASCULAR SURGICAL CENTER LLC | 820905971 - (TX) HUMBLE VASCULAR SURGICAL CENTER LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 63042 | $4603.00 | 1891881926 - GASTRO-SURGI CENTER OF NEW JERSEY | 223472632 - (NJ) GASTRO-SURGI CENTER OF NJ | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 63042 | $3000.00 | 1710038534 - OUTPATIENT SURGICAL SPECIALTIES CENTER, LLC | 205596163 - (NE) OUTPATIENT SURGICAL SPECIALTIES CENTER LLC | NE | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 63042 | $647.00 | 1134293814 - PLYMOUTH LASER CENTER, P.C., PLYMOUTH LASER & SURGICAL CENTER | 43292630 - (MA) PLYMOUTH LASER CENTER PC | MA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 63042 | $5414.08 | 1699252395 - LINDUSTRIES, LLC, SEVENTH AVENUE SURGERY CENTER | 825145499 - (NE) LINDUSTRIES LLC | NE | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 63042 | $1645.00 | 1750609731 - BELTLINE SURGERY CENTER, LLC | 262639054 - (TX) BELTLINE SURGERY CENTER LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 63042 | $7319.00 | 1326097981 - FREDERICKSBURG AMBULATORY SURGERY CENTER, LLC | 562322548 - (VA) FREDERICKSBURG AMBULATORY SURGERY CENTER LLC | VA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 63042 | $3606.00 | 1932145109 - VALLEY DIGESTIVE CENTER INC, VALLEY DIGESTIVE HEALTH CENTER | 204484163 | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 63042 | $3150.00 | 1881687614 - TURKS HEAD SURGERY CENTER LLC | 200184603 - (PA) TURK'S HEAD SURGERY CENTER, L.L.C. | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 63042 | $1064.00 | 1700828423 - SOUTHWESTERN EYE CENTER LTD, SOUTHWESTERN EYE CENTER | 860423068 - SOUTHWESTERN EYE CENTER, LTD. | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 63042 | $7275.00 | 1770252868 - STONESPRINGS SURGICENTER, LLC | 812929320 - (VA) STONESPRINGS SURGICENTER LLC | VA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 63042 | $867.00 | 1922075969 - SAINT MARY'S AMBULATORY SURGERY | 550837980 - (NJ) SAINT MARYS AMBULATORY SURGERY | NJ | 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 63042 vs. Other Surgical Procedures on the Nervous System Codes
The CPT 63042 code is part of the Surgery services used for Surgical Procedures on the Nervous 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 63042 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 |
|---|---|---|
| 63040-CPT | High | Laminotomy (Hemilaminectomy), With Decompression Of Nerve Root(S), Including Partial Facetectomy, Foraminotomy And/Or Excision Of Herniated Intervertebral Disc, Reexploration, Single Interspace; Cervical |
| 63042-CPT | High | Laminotomy (Hemilaminectomy), With Decompression Of Nerve Root(S), Including Partial Facetectomy, Foraminotomy And/Or Excision Of Herniated Intervertebral Disc, Reexploration, Single Interspace; Lumbar |
| 63043-CPT | Moderate | Laminotomy (Hemilaminectomy) With Decompression Of Nerve Root(S) Including Partial Facetectomy Foraminotomy And/Or Excision Of Herniated Intervertebral Disk Reexploration Single Interspace; Each Additional Cervical Interspace (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 63042. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 63042 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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