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CPT code 42500: Duct repair, salivary duct2026 Medicare rate & RVUs in San Benito County, CA

Repair of an injured or disrupted salivary duct, reported when the surgeon restores duct continuity rather than creating a diversion.

CMS RVU26DEffective Oct 1, 2026One payment locality258 Medicare services in 2024

In San Benito County, CA, Medicare pays $580.77 for 42500 in the office and $385.22 when it’s performed in a hospital or facility.

$580.77Office (non-facility)
$385.22Hospital or facility
+29.4%vs the national office rate ($448.91)

Check a contract rate as a % of Medicare · 42500 nationwide

Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.

We’ll open 42500 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in San Benito County, CA
  2. What 42500 covers
  3. Compared with other areas
  4. Rate map
  5. How it’s calculated
  6. Payment rules
  7. Related codes
  8. Rate history
  9. Where it applies
  10. Billing questions
  11. Sources

What 42500 covers

The surgeon repairs a damaged salivary duct to restore the flow of saliva, such as after a duct injury near the cheek or inside the mouth. Otolaryngologists, oral and maxillofacial surgeons, and other surgeons familiar with salivary duct anatomy may perform the repair, commonly in an operating room. The operative report should identify the duct and describe the injury and repair performed.

Report this code for the duct repair itself, not for a procedure that redirects the duct to a different opening. The record should support the need for repair and the work performed. This major surgery code includes the day-before preoperative visit and 90 days of related postoperative care. When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% multiple procedure reduction. Modifier 50 is inappropriate for this code. An assistant at surgery is paid only when medical necessity is documented; co-surgeons and team surgery are not permitted.

This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.

How San Benito County, CA compares for 42500

Across 109 of 109 payment localities, the office rate for 42500 runs from $398.79 in Arkansas to $580.77 in San Benito County, CA. San Benito County, CA pays $580.77. The RVUs are the same everywhere; the geographic indexes change the dollars.

42500 in San Benito County, CA vs other payment areas
  1. San Benito County, CA · this page$580.77
  2. Bakersfield, CA · California$470.83−$109.94
  3. Chico, CA · California$469.03−$111.74
  4. El Centro, CA · California$469.14−$111.63
  5. Fresno, CA · California$469.03−$111.74
  6. Hanford, CA · California$469.03−$111.74
  7. Los Angeles, CA · California$499.87−$80.90

Other areas in California first, then benchmark localities. Bars start at $0.

Every other payment area

42500 in every other Medicare payment locality
Payment localityOfficeFacility
Madera, CACalifornia$469.03$320.41
Merced, CACalifornia$469.03$320.41
Modesto, CACalifornia$469.03$320.41
Napa, CACalifornia$538.18$359.45
Oxnard, CACalifornia$496.86$336.58
Redding, CACalifornia$469.03$320.41
Rest of CaliforniaCalifornia$469.03$320.41
Riverside, CACalifornia$475.74$327.12

42500 rates by state

Office rate range in each state. Select a state to see its payment localities.

MEWIVTNHMTNDMNMINYMARIWAIDWYSDIAILINOHPANJCTORNVUTCONEMOKYWVVAMDDECAAZNMKSOKARTNNCSCDCTXLAMSALGAFLAKHI

Explore a state

Local rates. Clear comparisons.

Hover or focus a tile to see its rate range. Select it to open the state’s fee schedule.

$398.79

$530.06

Color shows the midpoint of each state’s locality range.

View every state and territory as a table
42500 office rate range by state
State / territoryOffice rate rangeLocalities
AK$530.061
AL$404.391
AR$398.791
AZ$437.111
CA$469.03–$580.7729
CO$464.291
CT$478.021
DC$509.621
DE$444.131
FL$446.82–$492.233
GA$422.19–$458.052
GU$479.131
HI$479.131
IA$412.261
ID$415.261
IL$435.84–$478.154
IN$417.511
KS$411.351
KY$415.601
LA$415.35–$434.952
MA$462.07–$507.682
MD$452.06–$509.623
ME$418.34–$438.712
MI$426.85–$453.172
MN$442.571
MO$409.14–$435.313
MS$403.991
MT$448.871
NC$422.391
ND$436.611
NE$414.141
NH$457.971
NJ$482.83–$504.862
NM$429.481
NV$445.731
NY$428.55–$529.595
OH$424.341
OK$413.881
OR$441.62–$477.462
PA$424.46–$467.152
PR$451.721
RI$458.791
SC$424.201
SD$435.161
TN$413.451
TX$421.86–$463.328
UT$429.741
VA$437.99–$509.622
VI$451.721
VT$435.841
WA$460.90–$516.842
WI$422.641
WV$420.601
WY$443.521

See 42500 in every payment locality

How the 42500 rate is calculated

Each of 42500’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.

How the rate is built · 42500

RVUs × geographic indexes × conversion factor

Office or facility?

Work4.31

4.31 RVUs× 1.000 GPCI

Practice expense8.51

8.51 RVUs× 1.000 GPCI

Malpractice0.62

0.62 RVUs× 1.000 GPCI

Adjusted RVUs

13.4400

Conversion factor

$33.4009

Medicare rate

$448.91

Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.

The exact San Benito County, CA inputs and CMS source lines

PPRRVU2026_Oct_nonQPP.csv

5,042

Code
42500
Physician work
4.31
Practice expense
8.51
Malpractice
0.62

GPCI2026.csv

26

Locality
San Benito County, CA
Physician work
1.110
Practice expense
1.442
Malpractice
0.536
Office calculation for 42500 in San Benito County, CA
ComponentRVULocality factorAdjusted
Physician work4.31× 1.1104.7841
Practice expense8.51× 1.44212.2714
Malpractice0.62× 0.5360.3323
Total RVUs17.3878
Conversion factor× 33.4009

Office rate, San Benito County, CA$580.77

Office: (4.31 × 1.11 + 8.51 × 1.442 + 0.62 × 0.536) × $33.4009 = $580.77

Facility: (4.31 × 1.11 + 4.45 × 1.442 + 0.62 × 0.536) × $33.4009 = $385.22

Open 42500 in the RVU calculator

Payment rules and modifiers for 42500

42500 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 42500

Duct repair, salivary duct

RuleCMS valueWhat it means
Global period090Major surgery: the day before, the day of, and 90 days after are included.
Multiple procedures2Standard reduction: highest-valued procedure at 100%, others at 50%.
Bilateral (modifier 50)0The 150% bilateral adjustment doesn’t apply.
Assistant at surgery (80/81/82/AS)0Not paid without supporting documentation.
Co-surgeons (62)0Not permitted.
Team surgery (66)0Not permitted.
Professional/technical0Physician service: no professional/technical split.
Split (54/55/56)0.09/0.81/0.10Share of the payment for pre-op, the procedure itself, and post-op care.

Global surgery period · 42500

Duct repair, salivary duct

90-day global period ends

Dec 30, 2026

Covers Sep 30, 2026 through Dec 30, 2026 (92 days, including the day before surgery).

Visit on Oct 31, 2026

Day 30 of the 90-day post-op period: related follow-up care is included in the surgical payment.

  • 24Unrelated E/M visit by the same physician
  • 79Unrelated procedure (starts its own global period)
  • 58Staged, more extensive, or therapy procedure that was planned
  • 78Unplanned return to the operating room for a related complication
SurgeryVisit
Sep 23, 2026Jan 10, 2027

Pre-op dayGlobal period

What modifiers do to the payment

Modifier 51 · payment effect

With and without the modifier

42500 without 51 · national office

$448.91

Duct repair, salivary duct

42500-51 · Second procedure: 50%

$224.46

When this isn’t the highest-valued procedure in the session, Medicare pays 50% of its fee schedule amount (the highest is paid at 100%).

When to use modifier 51

Codes related to 42500

Related codes aren’t interchangeable: bill the code that matches the service performed.

Codes related to 42500
CodeHow it relatesOffice range, San Benito County, CA
Same family
42505Salivary duct repair, secondary, complicatedA related salivary duct repair code; distinguish it by the repair performed and the applicable descriptor.$732.40
Used instead
42507Parotid duct diversion, bilateral procedureA parotid duct diversion code for redirecting the duct rather than repairing its continuity.No office rate
42509Parotid duct diversion, bilateralAnother parotid duct diversion option; use when the documented procedure redirects the duct.No office rate
42510Parotid duct diversion, bilateral duct reroutingA parotid duct diversion code, distinct from repair of a damaged duct.No office rate

How 42500 has changed in San Benito County, CA

42500 · Office / nonfacility

$580.77

Effective 2026-10-01

The base rate is $16.98 higher than on 2025-10-01, moving from $563.79 to $580.77 (3.0%).

It is unchanged from the immediately preceding available release, effective 2026-07-01.

Base rate by release · bars start at $0 · select a bar to compare

One bar per available release, ordered by effective date. Missing rates remain gaps. These comparisons hold the code, setting and locality identifiers constant; they do not isolate which policy or input caused a change.

What changed, release by release

  1. January 1, 2026

    RVU26A

    $563.79changed to$580.77

    • Conversion factor 32.3465 changed to 33.4009
    • Work RVU 4.42 changed to 4.31
    • Practice expense RVU 8.52 changed to 8.51
    • Malpractice RVU 0.61 changed to 0.62
    • Work GPCI 1.100 changed to 1.110
    • Practice expense GPCI 1.435 changed to 1.442
    • Malpractice GPCI 0.560 changed to 0.536

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $582.58changed to$563.79

    • Conversion factor 33.2875 changed to 32.3465
    • Practice expense RVU 8.57 changed to 8.52

    Held through RVU25B, RVU25C, RVU25D.

  3. March 9, 2024

    RVU24AR

    $573.07changed to$582.58

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $586.18changed to$573.07

    • Conversion factor 33.8872 changed to 32.7442
    • Practice expense RVU 8.59 changed to 8.57
    • Malpractice RVU 0.59 changed to 0.61
    • Work GPCI 1.098 changed to 1.100
    • Practice expense GPCI 1.409 changed to 1.435
    • Malpractice GPCI 0.579 changed to 0.560

  5. January 1, 2023

    RVU23A

    $583.50changed to$586.18

    • Conversion factor 34.6062 changed to 33.8872
    • Practice expense RVU 8.43 changed to 8.59
    • Malpractice RVU 0.60 changed to 0.59
    • Work GPCI 1.096 changed to 1.098
    • Practice expense GPCI 1.383 changed to 1.409
    • Malpractice GPCI 0.597 changed to 0.579

    Held through RVU23B, RVU23C, RVU23D.

  6. January 1, 2022

    RVU22A

    $562.34changed to$583.50

    • Conversion factor 34.8931 changed to 34.6062
    • Practice expense RVU 8.25 changed to 8.43
    • Malpractice RVU 0.59 changed to 0.60
    • Work GPCI 1.084 changed to 1.096
    • Practice expense GPCI 1.330 changed to 1.383

    Held through RVU22B, RVU22C, RVU22D.

  7. January 1, 2021

    RVU21A

    $528.66changed to$562.34

    • Conversion factor 36.0896 changed to 34.8931
    • Practice expense RVU 7.49 changed to 8.25
    • Malpractice RVU 0.57 changed to 0.59
    • Work GPCI 1.072 changed to 1.084
    • Practice expense GPCI 1.279 changed to 1.330
    • Malpractice GPCI 0.580 changed to 0.597

    Held through RVU21B, RVU21C, RVU21D.

  8. January 1, 2020

    RVU20A

    $505.38changed to$528.66

    • Conversion factor 36.0391 changed to 36.0896
    • Practice expense RVU 7.42 changed to 7.49
    • Malpractice RVU 0.65 changed to 0.57
    • Work GPCI 1.052 changed to 1.072
    • Practice expense GPCI 1.214 changed to 1.279
    • Malpractice GPCI 0.562 changed to 0.580

    Held through RVU20B, RVU20C, RVU20D.

  9. January 1, 2019

    RVU19A

    $485.06changed to$505.38

    • Conversion factor 35.9996 changed to 36.0391
    • Practice expense RVU 7.29 changed to 7.42
    • Work GPCI 1.041 changed to 1.052
    • Practice expense GPCI 1.167 changed to 1.214

    Held through RVU19B, RVU19C, RVU19D.

  10. January 1, 2018

    RVU18AR1

    $476.29changed to$485.06

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 7.42 changed to 7.29
    • Work GPCI 1.031 changed to 1.041
    • Practice expense GPCI 1.121 changed to 1.167
    • Malpractice GPCI 0.610 changed to 0.562

    Held through RVU18B, RVU18C, RVU18D.

  11. January 1, 2017

    RVU17A

    No ratechanged to$476.29

    Held through RVU17B, RVU17C, RVU17D.

  12. January 1, 2013

    RVU13AR

    Earliest loaded release: No rate

    Held through RVU13B, RVU13C, RVU13D, RVU14A, RVU14B, RVU14C, RVU14D, RVU15A, RVU15B, RVU15C, RVU15D, RVU16A, RVU16B, RVU16C, RVU16D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$580.77$385.22RVU26D
2026-07-01$580.77$385.22RVU26C
2026-04-01$580.77$385.22RVU26B
2026-01-01$580.77$385.22RVU26A
2025-10-01$563.79$422.68RVU25D
2025-07-01$563.79$422.68RVU25C
2025-04-01$563.79$422.68RVU25B
2025-01-01$563.79$422.68RVU25A
2024-10-01$582.58$433.07RVU24D
2024-07-01$582.58$433.07RVU24C
2024-04-01$582.58$433.07RVU24B
2024-03-09$582.58$433.07RVU24AR
2024-01-01$573.07$426.00RVU24A
2023-10-01$586.18$434.35RVU23D
2023-07-01$586.18$434.35RVU23C
2023-04-01$586.18$434.35RVU23B
2023-01-01$586.18$434.35RVU23A
2022-10-01$583.50$430.83RVU22D
2022-07-01$583.50$430.83RVU22C
2022-04-01$583.50$430.83RVU22B
2022-01-01$583.50$430.83RVU22A
2021-10-01$562.34$416.62RVU21D
2021-07-01$562.34$416.62RVU21C
2021-04-01$562.34$416.62RVU21B
2021-01-01$562.34$416.62RVU21A
2020-10-01$528.66$400.80RVU20D
2020-07-01$528.66$400.80RVU20C
2020-04-01$528.66$400.80RVU20B
2020-01-01$528.66$400.80RVU20A
2019-10-01$505.38$387.69RVU19D
2019-07-01$505.38$387.69RVU19C
2019-04-01$505.38$387.69RVU19B
2019-01-01$505.38$387.69RVU19A
2018-10-01$485.06$376.67RVU18D
2018-07-01$485.06$376.67RVU18C
2018-04-01$485.06$376.67RVU18B
2018-01-01$485.06$376.67RVU18AR1
2017-10-01$476.29$371.69RVU17D
2017-07-01$476.29$371.69RVU17C
2017-04-01$476.29$371.69RVU17B
2017-01-01$476.29$371.69RVU17A
2016-10-01Rate data unavailableRate data unavailableRVU16D
2016-07-01Rate data unavailableRate data unavailableRVU16C
2016-04-01Rate data unavailableRate data unavailableRVU16B
2016-01-01Rate data unavailableRate data unavailableRVU16A
2015-10-01Rate data unavailableRate data unavailableRVU15D
2015-07-01Rate data unavailableRate data unavailableRVU15C
2015-04-01Rate data unavailableRate data unavailableRVU15B
2015-01-01Rate data unavailableRate data unavailableRVU15A
2014-10-01Rate data unavailableRate data unavailableRVU14D
2014-07-01Rate data unavailableRate data unavailableRVU14C
2014-04-01Rate data unavailableRate data unavailableRVU14B
2014-01-01Rate data unavailableRate data unavailableRVU14A
2013-10-01Rate data unavailableRate data unavailableRVU13D
2013-07-01Rate data unavailableRate data unavailableRVU13C
2013-04-01Rate data unavailableRate data unavailableRVU13B
2013-01-01Rate data unavailableRate data unavailableRVU13AR

Price 42500 for an earlier date of service

Where the San Benito County, CA rate applies

San Benito County, CA is a Medicare payment area, not a city. Our Census mapping connects it to 5 cities and communities in California. Some span more than one payment area; confirm with the service ZIP.

  • 42500 in Aromas · multiple payment areas
  • Hollister
  • Ridgemark
  • San Juan Bautista
  • Tres Pinos

Browse all communities in California

42500 billing questions

How is duct repair different from parotid duct diversion?

Repair restores an injured or disrupted duct. Diversion redirects the duct to a different opening, so select the code that matches the operation documented.

What documentation supports this code?

Document the affected duct, the injury or defect, and the steps taken to restore duct continuity. The operative note should distinguish repair from redirection.

Can modifier 50 be reported?

No. Modifier 50 is inappropriate for this code based on its descriptor and anatomy.

What postoperative care is included?

The major-surgery global period includes the day-before preoperative visit and 90 days of related postoperative care.

Can an assistant surgeon or co-surgeon be reported?

Assistant-at-surgery payment requires documentation of medical necessity. Co-surgeons and team surgery are not permitted for this code.

Where these rates come from

FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.

CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027

Show the CMS file lines behind this rate
RVUs for 42500PPRRVU2026_Oct_nonQPP.csv, line 5,042 (RVU26D)
Geographic factors for San Benito County, CAGPCI2026.csv, line 26 (RVU26D)

Open CMS sourceHow we calculate rates

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