Rate Benchmarking
Compare your rates with similar providers.
Select a published rate, define comparable providers, and see where that rate falls in your market.
See a sample rate comparisonHCPCS T2042 Fee Schedule
Last Verified: September 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.
Hospice routine home care; per diem
| Key Fact | Detail |
|---|---|
| Service Type | National Codes Established for State Medicaid Agencies Hospice Care |
| Common Place of Service | None 99 - Other POS |
| Complexity Level | Low |
National average reimbursement for HCPCS T2042 by major payers:
$74.42
$67.10
$78.98
$136.07
Compare published rates across providers.
Choose a payer to see a sample of rates for HCPCS T2042.
HCPCS T2042
No sample rates available for this payer and code. Search provider rates to explore coverage.
Get a free rate benchmark for your specialty.
Choose your state and specialty to build a report from payer-published rates.
Use market rates to prepare your payer proposal.
Payer Contract Negotiation
Draft a fee schedule renegotiation letter.
Use your fee schedule and market benchmarks to set target rates and draft a letter for your payer.
See a sample payer proposalHCPCS T2042 vs. Other Hospice Care Codes
The HCPCS T2042 code is part of the National Codes Established for State Medicaid Agencies services used for Hospice Care. 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 T2042 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 |
|---|---|---|
| T2041-HCPCS | Low | Supports brokerage, self-directed, waiver; per 15 minutes |
| T2042-HCPCS | Low | Hospice routine home care; per diem |
| T2043-HCPCS | Low | Hospice continuous home care; per hour |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including HCPCS T2042. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the T2042 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.
FREE SAMPLE MARKET COMPARISON
Let's review your payer contracts side-by-side with the market.
Bring your top codes (like HCPCS T2042) and we'll show you how you compare in 15 minutes or less.