CPT 82042 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 | • Pathology and Laboratory Procedures • Chemistry Procedures |
| Common Place of Service | • 11 - Office • 21 - Inpatient Hospital |
| Common Modifiers | • None • 26 - Professional component • QW - CLIA Waived Tests |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 82042 |
National average reimbursement for CPT 82042 by major payers:
$6.64
$4.42
$7.33
$11.37
| 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 82042 | ||||||
United | 82042 | $7.78 | 1073502985 - CHU CHEN | 42484572 - MERRIMACK VALLEY PEDIATRIC ASSOCIATES, INC. | MA | Pediatrics Physician (208000000X) |
United | 82042 | $7.00 | 1467496802 - ST FRANCIS HOSPITAL, INC., ST. FRANCIS EASTSIDE | 582504530 - (SC) ST FRANCIS HOSPITAL INC | SC | General Acute Care Hospital (282N00000X) |
United | 82042 | $7.78 | 1598766495 - OUR LADY OF LOURDES REGIONAL MEDICAL CENTER,INC | 720423635 - OUR LADY OF LOURDES REGIONAL MEDICAL CENTER INC | LA | General Acute Care Hospital (282N00000X) |
United | 82042 | $3.26 | 1407191984 - BSA HOSPITAL LLC | 300754305 | TX | General Acute Care Hospital (282N00000X) |
United | 82042 | $7.78 | 1184911877 - VHS BROWNSVILLE HOSPITAL COMPANY LLC, VALLEY BAPTIST MEDICAL CENTER - BROWNSVILLE | 452663071 | TX | General Acute Care Hospital (282N00000X) |
United | 82042 | $3.26 | 1295736734 - CHRISTUS HEALTH ARK-LA-TEX, CHRISTUS ST. MICHAEL HEALTH SYSTEM | 752749681 - (TX) CHRISTUS HEALTH ARKLATEX | TX | General Acute Care Hospital (282N00000X) |
United | 82042 | $7.78 | 1093793408 - JACKSON PARISH HOSPITAL, JACKSON PARISH HOSPITAL | 720549907 | LA | Critical Access Hospital (282NC0060X) |
United | 82042 | $7.78 | 1467129700 - VHS SAN ANTONIO PARTNERS, LLC, NORTHEAST BAPTIST HOSPITAL | 760714523 | TX | General Acute Care Hospital (282N00000X) |
United | 82042 | $3.26 | 1740453000 - GRAHAM REGIONAL MEDICAL CENTER, GRAHAM GENERAL HSOPITAL PHYSICIANS | 751609992 | TX | General Acute Care Hospital (282N00000X) |
United | 82042 | $7.78 | 1912943184 - WOMAN'S HOSPITAL FOUNDATION, WOMAN'S HOSPITAL | 720652905 - (LA) WOMANS HOSPITAL FOUNDATION | LA | General Acute Care Hospital (282N00000X) |
United | 82042 | $4.34 | 1962024026 - CLHG-RUSTON LLC | 844422249 | LA | General Acute Care Hospital (282N00000X) |
United | 82042 | $7.55 | 1225031495 - MONROE SURGICAL HOSPITAL, LLC | 721479756 - (LA) MONROE SURGICAL HOSPITAL | LA | General Acute Care Hospital (282N00000X) |
United | 82042 | $7.78 | 1982604021 - GEORGETOWN MEMORIAL HOSPITAL, TIDELANDS GEORGETOWN MEMORIAL HOSPITAL | 570341194 - GEORGETOWN MEMORIAL HOSPITAL | SC | General Acute Care Hospital (282N00000X) |
United | 82042 | $4.21 | 1467442418 - NORTHWEST TEXAS HEALTHCARE SYSTEM INC, NORTHWEST TEXAS HEALTHCARE SYSTEM | 232238976 | TX | General Acute Care Hospital (282N00000X) |
United | 82042 | $3.03 | 1649224825 - JONES COUNTY REGIONAL HEALTHCARE SYSTEM, STAMFORD MEMORIAL HOSPITAL | 461285811 - (TX) JONES COUNTY REGIONAL HEALTHCARE SYSTEM | TX | General Acute Care Hospital (282N00000X) |
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 82042 vs. Other Chemistry Procedures Codes
The CPT 82042 code is part of the Pathology and Laboratory Procedures services used for Chemistry 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 82042 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 |
|---|---|---|
| 82042-CPT | Low | Albumin; Other Source Quantitative Each Specimen(Desc Revised 1/1/2018) |
| 82043-CPT | Low | Albumin; Urine (Eg Microalbumin) Quantitative (Desc Revised 1/1/2018) |
| 82044-CPT | Low | Albumin; Urine (Eg Microalbumin) Semiquantitative (Eg Reagent Strip Assay) (Desc Revised 1/1/2018) |
| 82045-CPT | Low | Albumin; Ischemia Modified |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 82042. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 82042 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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