HCPCS S4042 Fee Schedule

HCPCS S4042 vs. Other ASSORTED OBSTETRICAL AND FERTILITY SERVICES Codes

The HCPCS S4042 code is part of the Temporary National Codes (Non-Medicare) services used for ASSORTED OBSTETRICAL AND FERTILITY SERVICES. 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 S4042 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.

What is a fee schedule?

A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including HCPCS S4042. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.

Understanding the S4042 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.