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CPT code 42500: Duct repair, salivary duct2026 Medicare rate & RVUs in Colorado

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 Colorado, Medicare pays $464.29 for 42500 in the office and $320.01 when it’s performed in a hospital or facility.

$464.29Office (non-facility)
$320.01Hospital or facility
+3.4%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 Colorado
  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 Colorado 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. Colorado pays $464.29. The RVUs are the same everywhere; the geographic indexes change the dollars.

42500 in Colorado vs other payment areas
  1. Colorado · this page$464.29
  2. Los Angeles, CA · California$499.87+$35.58
  3. Washington, DC area · District of Columbia$509.62+$45.33
  4. Miami, FL · Florida$492.23+$27.94
  5. Chicago, IL · Illinois$478.15+$13.86
  6. Manhattan, NY · New York$516.30+$52.01
  7. Alaska · Alaska$530.06+$65.77

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

Every other payment area

42500 in every other Medicare payment locality
Payment localityOfficeFacility
AlabamaAlabama$404.39$285.73
ArkansasArkansas$398.79$282.30
ArizonaArizona$437.11$305.71
Bakersfield, CACalifornia$470.83$322.21
Chico, CACalifornia$469.03$320.41
El Centro, CACalifornia$469.14$320.51
Fresno, CACalifornia$469.03$320.41
Hanford, CACalifornia$469.03$320.41

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 Colorado 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

37

Locality
Colorado
Physician work
1.012
Practice expense
1.064
Malpractice
0.781
Office calculation for 42500 in Colorado
ComponentRVULocality factorAdjusted
Physician work4.31× 1.0124.3617
Practice expense8.51× 1.0649.0546
Malpractice0.62× 0.7810.4842
Total RVUs13.9006
Conversion factor× 33.4009

Office rate, Colorado$464.29

Office: (4.31 × 1.012 + 8.51 × 1.064 + 0.62 × 0.781) × $33.4009 = $464.29

Facility: (4.31 × 1.012 + 4.45 × 1.064 + 0.62 × 0.781) × $33.4009 = $320.01

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, Colorado
Same family
42505Salivary duct repair, secondary, complicatedA related salivary duct repair code; distinguish it by the repair performed and the applicable descriptor.$591.70
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 Colorado

42500 · Office / nonfacility

$464.29

Effective 2026-10-01

The base rate is $13.66 higher than on 2025-10-01, moving from $450.63 to $464.29 (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

    $450.63changed to$464.29

    • 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 1.008 changed to 1.012
    • Practice expense GPCI 1.053 changed to 1.064
    • Malpractice GPCI 0.827 changed to 0.781

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $465.49changed to$450.63

    • 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

    $457.90changed to$465.49

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $472.11changed to$457.90

    • 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 1.005 changed to 1.008
    • Practice expense GPCI 1.050 changed to 1.053
    • Malpractice GPCI 0.797 changed to 0.827

  5. January 1, 2023

    RVU23A

    $474.48changed to$472.11

    • 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 1.001 changed to 1.005
    • Practice expense GPCI 1.047 changed to 1.050
    • Malpractice GPCI 0.767 changed to 0.797

    Held through RVU23B, RVU23C, RVU23D.

  6. January 1, 2022

    RVU22A

    $471.57changed to$474.48

    • 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

    Held through RVU22B, RVU22C, RVU22D.

  7. January 1, 2021

    RVU21A

    $457.36changed to$471.57

    • 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 1.000 changed to 1.001
    • Practice expense GPCI 1.033 changed to 1.047
    • Malpractice GPCI 0.905 changed to 0.767

    Held through RVU21B, RVU21C, RVU21D.

  8. January 1, 2020

    RVU20A

    $455.93changed to$457.36

    • 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
    • Practice expense GPCI 1.018 changed to 1.033
    • Malpractice GPCI 1.042 changed to 0.905

    Held through RVU20B, RVU20C, RVU20D.

  9. January 1, 2019

    RVU19A

    $450.66changed to$455.93

    • Conversion factor 35.9996 changed to 36.0391
    • Practice expense RVU 7.29 changed to 7.42

    Held through RVU19B, RVU19C, RVU19D.

  10. January 1, 2018

    RVU18AR1

    $453.78changed to$450.66

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 7.42 changed to 7.29
    • Practice expense GPCI 1.015 changed to 1.018
    • Malpractice GPCI 1.066 changed to 1.042

    Held through RVU18B, RVU18C, RVU18D.

  11. January 1, 2017

    RVU17A

    $456.95changed to$453.78

    • Conversion factor 35.8043 changed to 35.8887
    • Practice expense RVU 7.54 changed to 7.42
    • Malpractice RVU 0.66 changed to 0.65
    • Practice expense GPCI 1.011 changed to 1.015
    • Malpractice GPCI 1.090 changed to 1.066

    Held through RVU17B, RVU17C, RVU17D.

  12. January 1, 2016

    RVU16A

    $457.20changed to$456.95

    • Conversion factor 35.9335 changed to 35.8043
    • Practice expense RVU 7.48 changed to 7.54
    • Malpractice RVU 0.68 changed to 0.66

    Held through RVU16B, RVU16C, RVU16D.

  13. July 1, 2015

    RVU15C

    $454.92changed to$457.20

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  14. January 1, 2015

    RVU15A

    $453.52changed to$454.92

    • Conversion factor 35.8228 changed to 35.7547
    • Practice expense RVU 7.62 changed to 7.48
    • Malpractice RVU 0.57 changed to 0.68
    • Practice expense GPCI 1.008 changed to 1.011
    • Malpractice GPCI 0.981 changed to 1.090

    Held through RVU15B.

  15. January 1, 2014

    RVU14A

    $454.09changed to$453.52

    • Conversion factor 34.0230 changed to 35.8228
    • Practice expense RVU 8.37 changed to 7.62
    • Malpractice RVU 0.60 changed to 0.57
    • Practice expense GPCI 1.004 changed to 1.008
    • Malpractice GPCI 0.872 changed to 0.981

    Held through RVU14B, RVU14C, RVU14D.

  16. January 1, 2013

    RVU13AR

    Earliest loaded release: $454.09

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$464.29$320.01RVU26D
2026-07-01$464.29$320.01RVU26C
2026-04-01$464.29$320.01RVU26B
2026-01-01$464.29$320.01RVU26A
2025-10-01$450.63$347.09RVU25D
2025-07-01$450.63$347.09RVU25C
2025-04-01$450.63$347.09RVU25B
2025-01-01$450.63$347.09RVU25A
2024-10-01$465.49$355.78RVU24D
2024-07-01$465.49$355.78RVU24C
2024-04-01$465.49$355.78RVU24B
2024-03-09$465.49$355.78RVU24AR
2024-01-01$457.90$349.97RVU24A
2023-10-01$472.11$358.96RVU23D
2023-07-01$472.11$358.96RVU23C
2023-04-01$472.11$358.96RVU23B
2023-01-01$472.11$358.96RVU23A
2022-10-01$474.48$358.90RVU22D
2022-07-01$474.48$358.90RVU22C
2022-04-01$474.48$358.90RVU22B
2022-01-01$474.48$358.90RVU22A
2021-10-01$471.57$356.86RVU21D
2021-07-01$471.57$356.86RVU21C
2021-04-01$471.57$356.86RVU21B
2021-01-01$471.57$356.86RVU21A
2020-10-01$457.36$354.10RVU20D
2020-07-01$457.36$354.10RVU20C
2020-04-01$457.36$354.10RVU20B
2020-01-01$457.36$354.10RVU20A
2019-10-01$455.93$357.24RVU19D
2019-07-01$455.93$357.24RVU19C
2019-04-01$455.93$357.24RVU19B
2019-01-01$455.93$357.24RVU19A
2018-10-01$450.66$356.11RVU18D
2018-07-01$450.66$356.11RVU18C
2018-04-01$450.66$356.11RVU18B
2018-01-01$450.66$356.11RVU18AR1
2017-10-01$453.78$359.07RVU17D
2017-07-01$453.78$359.07RVU17C
2017-04-01$453.78$359.07RVU17B
2017-01-01$453.78$359.07RVU17A
2016-10-01$456.95$362.11RVU16D
2016-07-01$456.95$362.11RVU16C
2016-04-01$456.95$362.11RVU16B
2016-01-01$456.95$362.11RVU16A
2015-10-01$457.20$362.02RVU15D
2015-07-01$457.20$362.02RVU15C
2015-04-01$454.92$360.22RVU15B
2015-01-01$454.92$360.22RVU15A
2014-10-01$453.52$358.91RVU14D
2014-07-01$453.52$358.91RVU14C
2014-04-01$453.52$358.91RVU14B
2014-01-01$453.52$358.91RVU14A
2013-10-01$454.09$354.69RVU13D
2013-07-01$454.09$354.69RVU13C
2013-04-01$454.09$354.69RVU13B
2013-01-01$454.09$354.69RVU13AR

Price 42500 for an earlier date of service

Where the Colorado rate applies

Colorado is a Medicare payment area, not a city. Our Census mapping connects it to 485 cities and communities in Colorado. Some span more than one payment area; confirm with the service ZIP.

  • Acres Green
  • Aetna Estates
  • Aguilar
  • Air Force Academy
  • Akron
  • Alamosa
  • Alamosa East
  • Allenspark

Browse all communities in Colorado

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 ColoradoGPCI2026.csv, line 37 (RVU26D)

Open CMS sourceHow we calculate rates

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