HCPCS A4642 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 | • Medical And Surgical Supplies • Diagnostic Radiopharmaceuticals |
| Complexity Level | Moderate |
National average reimbursement for HCPCS A4642 by major payers:
$742.81
$1,700.88
$1,415.88
$1,323.66
| 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 HCPCS A4642 | ||||||
United | A4642 | $1675.00 | 1225339898 - SCREVEN COUNTY HOSPITAL, LLC, OPTIM MEDICAL CENTER - SCREVEN | 273100946 | GA | Critical Access Hospital (282NC0060X) |
United | A4642 | $1675.00 | 1255401519 - THE MEDICAL CENTER INC, PIEDMONT COLUMBUS REGIONAL MIDTOWN | 581685139 - (GA) THE MEDICAL CENTER INC | GA | General Acute Care Hospital (282N00000X) |
United | A4642 | $1675.00 | 1306890942 - BROOKS COUNTY HOSPITAL | 586002830 | GA | Critical Access Hospital (282NC0060X) |
United | A4642 | $3204.68 | 1255401519 - THE MEDICAL CENTER INC, PIEDMONT COLUMBUS REGIONAL MIDTOWN | 581685139 - (GA) THE MEDICAL CENTER INC | GA | General Acute Care Hospital (282N00000X) |
United | A4642 | $1507.50 | 1255478004 - CHRISTOPHER RAIO | 111888924 - GOOD SAMARITAN HOSPTIAL MEDICAL CENTER | NY | Emergency Medicine Physician (207P00000X) |
United | A4642 | $1675.00 | 1194779702 - JOHN D. ARCHBOLD MEMORIAL HOSPITAL, INC. | 580566121 - JOHN D ARCHBOLD MEMORIAL HOSPITAL INC | GA | General Acute Care Hospital (282N00000X) |
United | A4642 | $1675.00 | 1922178789 - SCOTTISH RITE CHILDRENS MEDICAL CTR, CHILDREN'S HEALTHCARE OF ATLANTA AT SCOTTISH RITE | 580572465 - CHILDRENS HEALTHCARE OF ATLANTA INC | GA | Children's Hospital (282NC2000X) |
United | A4642 | $3204.68 | 1467406132 - EASTSIDE MEDICAL CENTER, LLC, PIEDMONT EASTSIDE MEDICAL CENTER | 582433432 | GA | General Acute Care Hospital (282N00000X) |
United | A4642 | $1675.00 | 1801844469 - AUGUSTA VAMC | 582089405 - AUGUSTA VAMC | GA | General Acute Care Hospital (282N00000X) |
United | A4642 | $1675.00 | 1902855216 - ATLANTA VAMC | 582091280 | GA | General Acute Care Hospital (282N00000X) |
United | A4642 | $1866.05 | 1851768337 - KELLY RIDGES | 362925195 - ALLERGY & ASTHMA OF DUPAGE, S.C. | IL | Family Nurse Practitioner (363LF0000X) |
United | A4642 | $1586.16 | 1255766531 - MARISSA LIVERIS | 362925195 - ALLERGY & ASTHMA OF DUPAGE, S.C. | IL | Physician Assistant (363A00000X) |
United | A4642 | $1675.00 | 1811000177 - CHARLESTON RADIOLOGISTS PA | 570634747 - CHARLESTON RADIOLOGISTS, P.A. | SC | Single Specialty Group (193400000X) |
United | A4642 | $1675.00 | 1730110826 - EVANS MEMORIAL HOSPITAL, INC. | 582257925 - (GA) EVANS MEMORIAL HOSPITAL INC | GA | General Acute Care Hospital (282N00000X) |
United | A4642 | $3204.68 | 1780638833 - CARTERSVILLE MEDICAL CENTER LLC, CARTERSVILLE MEDICAL CENTER | 582433438 - (GA) CARTERSVILLE MEDICAL CENTER LLC | GA | 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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HCPCS A4642 vs. Other Diagnostic Radiopharmaceuticals Codes
The HCPCS A4642 code is part of the Medical And Surgical Supplies services used for Diagnostic Radiopharmaceuticals. 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 HCPCS A4642 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 |
|---|---|---|
| A4641-HCPCS | Moderate | Radiopharmaceutical, diagnostic, not otherwise classified |
| A4642-HCPCS | Moderate | Indium In-111 satumomab pendetide, diagnostic, per study dose, up to 6 millicuries |
| A4648-HCPCS | Low | Tissue marker, implantable, any type, each |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including HCPCS A4642. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the A4642 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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