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See a sample rate comparisonHCPCS S4042 Fee Schedule
Last Verified: October 2026
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.
Management of ovulation induction (interpretation of diagnostic tests and studies, non-face-to-face medical management of the patient), per cycle
| Key Fact | Detail |
|---|---|
| Service Type | Temporary National Codes (Non-Medicare) Assorted Obstetrical and Fertility Services |
| Common Place of Service | 11 - Office 24 - Ambulatory Surgical Center None |
| Complexity Level | Moderate |
National average reimbursement for HCPCS S4042 by major payers:
$247.33
$310.78
$41.44
$139.71
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HCPCS S4042
5 of 25 sample ratesHigher to lower in this preview
Dan Goldschlag
$959.04Published rateSteven Spandorfer
$959.04Published rateSamantha Pfeifer
$959.04Published rateBeth Mcavey
Rma Long Island Ivf, PLLC
$252.13Published rateBeth Mcavey
Rma Long Island Ivf, PLLC
$226.91Published rate
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See a sample payer proposalHCPCS 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.
| Code | Complexity | Description |
|---|---|---|
| S4040-HCPCS | Low | Monitoring and storage of cryopreserved embryos, per 30 days |
| S4042-HCPCS | Moderate | Management of ovulation induction (interpretation of diagnostic tests and studies, non-face-to-face medical management of the patient), per cycle |
| S4981-HCPCS | Low | Insertion of levonorgestrel-releasing intrauterine system |
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.
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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