CPT 93242 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 | • Medicine Services and Procedures • Cardiovascular Procedures |
| Common Place of Service | • 11 - Office • 22 - On Campus Outpatient Hospital |
| Common Modifiers | • None • 59 - Distinct Procedural Service • PO - Services, procedures and/or surgeries furnished at off-campus provider-based outpatient departments |
| Complexity Level | Low |
National average reimbursement for CPT 93242 by major payers:
$17.03
$20.80
$18.77
$31.43
| 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 93242 | ||||||
United | 93242 | $19.82 | 1639164486 - SAQUIBA SYED | 454578825 - ALPINE MEDICAL GROUP LLC | NJ | Internal Medicine Physician (207R00000X) |
United | 93242 | $56.58 | 1679607212 - JAN MRANI | 391947472 | NJ | Internal Medicine Physician (207R00000X) |
United | 93242 | $18.73 | 1710994439 - RUBY SALUJA | 205533075 - (NJ) HARTSHORN ASSOCIATES INC | NJ | Internal Medicine Physician (207R00000X) |
United | 93242 | $14.43 | 1346829918 - DAVID ELSON | 352221375 - (NJ) INTEGRATED MEDICAL CARE LLC | NJ | Internal Medicine Physician (207R00000X) |
United | 93242 | $18.31 | 1457368680 - SHODHAN PATEL | 811200310 - CAPITAL HEALTH MULTISPECIALTY GROUP | NJ | Internal Medicine Physician (207R00000X) |
United | 93242 | $18.11 | 1043516636 - PAOLO SALVATORE | 140666386 | NJ | Internal Medicine Physician (207R00000X) |
United | 93242 | $12.77 | 1508961772 - RICHARD SENZER | 842584500 - (NJ) RICHARD SENZER MD LLC | NJ | Internal Medicine Physician (207R00000X) |
United | 93242 | $19.77 | 1184672172 - WILLIAM DIGIACOMO | 223298205 | NJ | Internal Medicine Physician (207R00000X) |
United | 93242 | $27.36 | 1891756573 - UMA DUVVURI | 223624559 - (NJ) RIVERSIDE MEDICAL GROUP | NJ | Internal Medicine Physician (207R00000X) |
United | 93242 | $15.25 | 1417960725 - NISHI SAHAY | 223264704 - (NJ) BARNEGAT MEDICAL ASSOCIATES P A | NJ | Internal Medicine Physician (207R00000X) |
United | 93242 | $17.39 | 1598807521 - IRENE HAO | 811200310 - CAPITAL HEALTH MULTISPECIALTY GROUP | NJ | Internal Medicine Physician (207R00000X) |
United | 93242 | $15.25 | 1053490359 - RAAFAT GHOBRAIEL | 205743386 - (NJ) FIRST HEALTH ASSOCIATES LLC | NJ | Internal Medicine Physician (207R00000X) |
United | 93242 | $15.39 | 1326231879 - REEM JABER-IQBAL | 271602305 - (NJ) RIDGEWOOD MEDICAL ASSOCIATES, LLC | NJ | Internal Medicine Physician (207R00000X) |
United | 93242 | $16.35 | 1265141444 - TRI AMERICA MEDICINE LLC | 874184685 - (NJ) TRI AMERICA MEDICINE LLC | NJ | Internal Medicine Physician (207R00000X) |
United | 93242 | $41.02 | 1861496457 - SUNIT DESAI | 223316007 - BARNABAS HEALTH MEDICAL GROUP P C | NJ | Internal Medicine Physician (207R00000X) |
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 93242 vs. Other Cardiovascular Procedures Codes
The CPT 93242 code is part of the Medicine Services and Procedures services used for Cardiovascular 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 93242 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 |
|---|---|---|
| 93016-CPT | Low | Cardiovascular Stress Test Using Maximal Or Submaximal Treadmill Or Bicycle Exercise Continuous Electrocardiographic Monitoring And/Or Pharmacological Stress; Supervision Only Without Interpre- Tation And Report (Revised 1/1/2013) |
| 93017-CPT | Low | Cardiovascular Stress Test Using Maximal Or Submaximal Treadmill Or Bicycle Exercise, Continuous Electrocardiographic Monitoring, And/Or Pharmacological Stress; Tracing Only, Without Interpretation And Report |
| 93241-CPT | Moderate | External Electrocardiographic Recording For More Than 48 Hours Up To 7 Days By Continuous Rhythm Recording And Storage; Includes Recording Scanning Analysis With Report Review And Interpretation |
| 93242-CPT | Low | External Electrocardiographic Recording For More Than 48 Hours Up To 7 Days By Continuous Rhythm Recording And Storage; Recording (Includes Connection And Initial Recording) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 93242. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 93242 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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