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 |
| Medicaid Fee Schedule | View Medicaid rates for 82042 |
National average reimbursement for CPT 82042 by major payers:
$6.64
$4.42
$7.33
$10.97
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 Protein Lab Test, Albumin Is A Protein Found In Urine Blood Spinal Fluid And Amniotic Fluid. Elevated Albumin In The Urine May Indicate Diabetes Or Pregnancy. In Other Fluids The Albumin Level Can Provide Information About Nutrition Status Or Disease. |
| 82043-CPT | Low | Albumin Protein Lab Test, Albumin Is A Protein Found In Urine Blood Spinal Fluid And Amniotic Fluid. Elevated Albumin In The Urine May Indicate Diabetes Or Pregnancy. In Other Fluids The Albumin Level Can Provide Information About Nutrition Status Or Disease. |
| 82044-CPT | Low | Albumin Protein Lab Test, Albumin Is A Protein Found In Urine Blood Spinal Fluid And Amniotic Fluid. Elevated Albumin In The Urine May Indicate Diabetes Or Pregnancy. In Other Fluids The Albumin Level Can Provide Information About Nutrition Status Or Disease. |
| 82045-CPT | Low | Heart Attack Protein Test, The Test Is Performed To Detect Acute Heart Injury. When Blood Flow To The Heart Has Been Blocked (Ischemia) Albumin Protein Will Be Unable To Bind To Testing Mediums. |
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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