CPT 70542 Fee Schedule
Healthcare providers use this code to document and receive reimbursement for visits that address moderate-level medical decision-making, often including multiple diagnoses or prescription management.
| Key Fact | Detail |
|---|---|
| Service Type | • Radiology Procedures • Diagnostic Radiology (Diagnostic Imaging) Procedures |
| Common Place of Service | • 11 - Office • 22 - On Campus Outpatient Hospital |
| Common Modifiers | • None • 26 - Professional component • TC - Technical component |
| Complexity Level | Moderate |
National average reimbursement for CPT 70542 by major payers:
$378.64
$466.34
$501.64
$535.12
| 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 70542 | ||||||
United | 70542 | $136.80 | 1780987073 - MARIAN LACY | 742410946 - NORTHERN ARIZONA HEALTHCARE CORPORATION | AZ | Hospitalist Physician (208M00000X) |
United | 70542 | $136.80 | 1134384415 - IMANI ROSARIO | 742410946 - NORTHERN ARIZONA HEALTHCARE CORPORATION | NJ | Urology Physician (208800000X) |
United | 70542 | $267.50 | 1023094406 - ALEXANDER FLOWER | 742410946 - NORTHERN ARIZONA HEALTHCARE CORPORATION | IA | Critical Care Medicine (Internal Medicine) Physician (207RC0200X) |
United | 70542 | $60.00 | 1588756076 - ALL WAYS HOMECARE INC | 202696236 | FL | Home Health Agency (251E00000X) |
United | 70542 | $70.87 | 1225052566 - CARRIE HEISINGER | 742410946 - NORTHERN ARIZONA HEALTHCARE CORPORATION | AZ | Physician Assistant (363A00000X) |
United | 70542 | $70.87 | 1730543067 - JORDAN SELZER | 742410946 - NORTHERN ARIZONA HEALTHCARE CORPORATION | NV | Emergency Medicine Physician (207P00000X) |
United | 70542 | $879.59 | 1053563965 - RAYMOND LIEBER | 742410946 - NORTHERN ARIZONA HEALTHCARE CORPORATION | AZ | Physician Assistant (363A00000X) |
United | 70542 | $136.80 | 1437644374 - JAMES DEES | 742410946 - NORTHERN ARIZONA HEALTHCARE CORPORATION | AZ | Anesthesiology Physician (207L00000X) |
United | 70542 | $1016.40 | 1790836252 - RANGADHAM NAGARAKANTI | 742410946 - NORTHERN ARIZONA HEALTHCARE CORPORATION | TX | Clinical Cardiac Electrophysiology Physician (207RC0001X) |
United | 70542 | $267.50 | 1699727784 - JEREMY PAYNE | 742410946 - NORTHERN ARIZONA HEALTHCARE CORPORATION | AZ | Neurology Physician (2084N0400X) |
United | 70542 | $1016.40 | 1376129387 - NICOLETTE CURRIE | 742410946 - NORTHERN ARIZONA HEALTHCARE CORPORATION | AZ | Orthopedic Physical Therapist (2251X0800X) |
United | 70542 | $267.50 | 1720391279 - MUHAMMAD KHAN | 742410946 - NORTHERN ARIZONA HEALTHCARE CORPORATION | AZ | Neurology Physician (2084N0400X) |
United | 70542 | $267.50 | 1962847517 - ELIZABETH BAY | 742410946 - NORTHERN ARIZONA HEALTHCARE CORPORATION | AZ | Internal Medicine Physician (207R00000X) |
United | 70542 | $879.59 | 1699233676 - CHAD MOODY | 742410946 - NORTHERN ARIZONA HEALTHCARE CORPORATION | IN | Certified Registered Nurse Anesthetist (367500000X) |
United | 70542 | $136.80 | 1356608152 - MEGAN RAYMAN | 742410946 - NORTHERN ARIZONA HEALTHCARE CORPORATION | AZ | Hospitalist Physician (208M00000X) |
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 70542 vs. Other Diagnostic Radiology (Diagnostic Imaging) Procedures Codes
The CPT 70542 code is part of the Radiology Procedures services used for Diagnostic Radiology (Diagnostic Imaging) Procedures. 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 70542 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 |
|---|---|---|
| 70492 | Moderate | Computerized Axial Tomography Soft Tissue Neck; Without Contrast Material Followed By Contrast Material(S) And Further Sections |
| 70540 | Moderate | Mri; Orbit, Face, & Neck |
| 70542 | Moderate | Mri, Orbit, Face, And Neck; With Contrast Material(S) |
| 70543 | Moderate | Magnetic Resonance (Eg, Proton) Imaging, Orbit, Face, And/Or Neck; Without Contrast Material(S), Followed By Contrast Material(S) And Further Sequences |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 70542. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 70542 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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