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 |
| Medicare Fee Schedule | View Medicare rates for 63042 |
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 | $1350.00 | 1497750426 - NEW ALBANY OUTPATIENT SURGERY, LLC, SURGICAL CENTER OF NEW ALBANY | 232722876 | IN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 63042 | $1959.00 | 1780021188 - ENDOSCOPY CENTER OF NIAGARA, LLC | 453630889 - (NY) ENDOSCOPY CENTER OF NIAGARA LLC | NY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 63042 | $8818.00 | 1023341740 - OPHTHALMOLOGY SURGERY CENTER OF DALLAS, LLC | 261914835 - (TX) OPHTHALMOLOGY SURGERY CENTER OF DALLAS | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 63042 | $2467.00 | 1821471913 - ARIZONA SURGICAL SPECIALISTS CENTER, LLC, ARIZONA SURGICAL SPECIALSTS CENTER WEST PHOENIX | 760737449 - (AZ) ARIZONA SURGICAL SPECIALISTS CENTER LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 63042 | $5000.00 | 1063819860 - TYLER ASC, LP, TYLER CARDIAC & ENDOVASCULAR SURGERY CENTER | 471418553 | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 63042 | $4000.00 | 1649870304 - PARKHILL SURGERY CENTER PLANO, LLC | 851803797 | TX | 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 | $5854.00 | 1447768411 - WISCONSIN INSTITUTE OF SURGICAL EXCELLENCE LLC | 821710492 - (WI) WISCONSIN INSTITUTE OF SURGICAL EXCELLENCE LLC | WI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 63042 | $6492.00 | 1366515504 - RIVERSIDE AMBULATORY SURGERY CENTER, LLC, THE ENDOSCOPY & COLONOSCOPY CENTER | 205227186 - (MO) RIVERSIDE AMBULATORY SURGERY CENTER LLC | MO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 63042 | $8394.00 | 1134431323 - BETHESDA CHEVY CHASE SURGERY CENTER, LLC | 272875760 - (MD) BETHESDA CHEVY CHASE SURGERY CEN | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 63042 | $390.00 | 1982696894 - AFFILIATED AMBULATORY SURGERY CENTER LLC | 311719268 - (OH) AFFILIATED AMBULATORY SURGERY CENTER, LLC | OH | 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 | $2900.00 | 1639237092 - MUSCULOSKELETAL AMBULATORY SURGERY CENTER INC, THE SURGERY CENTER AT POINTE WEST | 650829385 - (FL) MUSCULOSKELETAL AMBULATORY SURGERY CENTER | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 63042 | $3348.00 | 1528253523 - MESQUITE TX ENDOSCOPY ASC LLC, TEXAS GI ENDOSCOPY CENTER | 260290859 - (TX) THE MESQUITE TX ENDOSCOPY ASC, LLC D.B.A | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 63042 | $6087.00 | 1942715826 - SAFETY HARBOR ASC COMPANY LLC, SAFETY HARBOR SURGERY CENTER | 320547161 | 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 |
Want to see your competitors' rates?
Start your trial today to unlock complete access to provider rates and fee schedules in your area.
Here's what you can do with PayerPrice
Renegotiate your managed care contracts
Benchmark your current rates against market averages to identify opportunities for rate optimization.
Prospect for new business using fee schedules
Access every provider's negotiated rates for every billing code in your market to inform your prospecting strategies.
Integrate real-time payer data into your workflows
Automatically keep fee schedules up-to-date without adding yet another log-in to your insurance systems. Connect via API or SQL.
PayerPrice shows you the exact negotiated rates that insurers publish under federal transparency rules.
We display the raw data directly from insurers' files, giving you the same information they make public. Learn more about Price Transparency.
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.
Let's review your payer contracts side-by-side with the market.
Bring your top codes (like CPT 63042) and we'll show you how you compare in 15 minutes or less.