CPT code 42500: Duct repair, salivary duct2026 Medicare rate & RVUs in Virginia
Repair of an injured or disrupted salivary duct, reported when the surgeon restores duct continuity rather than creating a diversion.
In Virginia, Medicare pays $437.99 for 42500 in the office and $304.69 when it’s performed in a hospital or facility.
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.
On this page 11 sections
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 Virginia 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. Virginia pays $437.99. The RVUs are the same everywhere; the geographic indexes change the dollars.
- Virginia · this page$437.99
- Los Angeles, CA · California$499.87+$61.88
- Washington, DC area · District of Columbia$509.62+$71.63
- Miami, FL · Florida$492.23+$54.24
- Chicago, IL · Illinois$478.15+$40.16
- Manhattan, NY · New York$516.30+$78.31
- Alaska · Alaska$530.06+$92.07
Other areas in Virginia first, then benchmark localities. Bars start at $0.
Every other payment area
| Payment locality | Office | Facility |
|---|---|---|
| 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 |
| 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 |
| Sacramento, CACalifornia | $490.81 | $333.10 |
| Salinas, CACalifornia | $488.96 | $331.79 |
| San Diego, CACalifornia | $499.45 | $337.27 |
| Marin County, CACalifornia | $567.92 | $376.71 |
| San Francisco, CACalifornia | $567.22 | $376.01 |
| San Benito County, CACalifornia | $580.77 | $385.22 |
| Santa Clara County, CACalifornia | $577.89 | $382.34 |
| San Luis Obispo, CACalifornia | $481.26 | $326.80 |
| Santa Cruz, CACalifornia | $503.43 | $338.67 |
| Santa Maria, CACalifornia | $490.51 | $332.40 |
| Santa Rosa, CACalifornia | $508.43 | $341.90 |
| Stockton, CACalifornia | $469.03 | $320.41 |
| Vallejo, CACalifornia | $537.16 | $358.43 |
| Visalia, CACalifornia | $469.03 | $320.41 |
| Yuba City, CACalifornia | $469.03 | $320.41 |
| ColoradoColorado | $464.29 | $320.01 |
| ConnecticutConnecticut | $478.02 | $331.97 |
| DelawareDelaware | $444.13 | $310.15 |
| Fort Lauderdale, FLFlorida | $469.34 | $331.97 |
| Rest of FloridaFlorida | $446.82 | $317.18 |
| Atlanta, GAGeorgia | $458.05 | $320.27 |
| Rest of GeorgiaGeorgia | $422.19 | $301.22 |
| Hawaii, Guam, HIHawaii | $479.13 | $324.94 |
| IowaIowa | $412.26 | $288.18 |
| IdahoIdaho | $415.26 | $290.50 |
| East St. Louis, ILIllinois | $447.17 | $322.41 |
| Rest of IllinoisIllinois | $435.84 | $312.03 |
| Suburban Chicago, ILIllinois | $473.58 | $334.31 |
| IndianaIndiana | $417.51 | $291.81 |
| KansasKansas | $411.35 | $288.76 |
| KentuckyKentucky | $415.60 | $295.04 |
| New Orleans, LALouisiana | $434.95 | $307.35 |
| Rest of LouisianaLouisiana | $415.35 | $295.34 |
| Metropolitan Boston, MAMassachusetts | $507.68 | $345.76 |
| Rest of MassachusettsMassachusetts | $462.07 | $319.28 |
| Baltimore area, MDMaryland | $476.87 | $331.36 |
| Rest of MarylandMaryland | $452.06 | $314.83 |
| Rest of MaineMaine | $418.34 | $293.58 |
| Southern Maine, MEMaine | $438.71 | $304.32 |
| Detroit, MIMichigan | $453.17 | $322.30 |
| Rest of MichiganMichigan | $426.85 | $303.04 |
| MinnesotaMinnesota | $442.57 | $303.03 |
| Metropolitan Kansas City, MOMissouri | $431.09 | $303.76 |
| Metropolitan St. Louis, MOMissouri | $435.31 | $306.21 |
| Rest of MissouriMissouri | $409.14 | $292.25 |
| MississippiMississippi | $403.99 | $287.24 |
| MontanaMontana | $448.87 | $313.26 |
| North CarolinaNorth Carolina | $422.39 | $295.87 |
| North DakotaNorth Dakota | $436.61 | $301.00 |
| NebraskaNebraska | $414.14 | $288.97 |
| New HampshireNew Hampshire | $457.97 | $316.81 |
| Northern New JerseyNew Jersey | $504.86 | $347.56 |
| Rest of New JerseyNew Jersey | $482.83 | $334.74 |
| New MexicoNew Mexico | $429.48 | $305.13 |
| NevadaNevada | $445.73 | $309.99 |
| NYC suburbs and Long Island, NYNew York | $529.59 | $368.35 |
| Poughkeepsie and northern NYC suburbs, NYNew York | $486.74 | $338.25 |
| Queens, NYNew York | $519.01 | $358.72 |
| Rest of New YorkNew York | $428.55 | $299.72 |
| OhioOhio | $424.34 | $300.53 |
| OklahomaOklahoma | $413.88 | $292.78 |
| Portland, OROregon | $477.46 | $326.80 |
| Rest of OregonOregon | $441.62 | $306.56 |
| Metropolitan Philadelphia, PAPennsylvania | $467.15 | $325.98 |
| Rest of PennsylvaniaPennsylvania | $424.46 | $299.97 |
| Puerto RicoPuerto Rico | $451.72 | $314.62 |
| Rhode IslandRhode Island | $458.79 | $318.70 |
| South CarolinaSouth Carolina | $424.20 | $298.90 |
| South DakotaSouth Dakota | $435.16 | $299.55 |
| TennesseeTennessee | $413.45 | $290.19 |
| Austin, TXTexas | $463.32 | $319.85 |
| Beaumont, TXTexas | $421.86 | $298.45 |
| Brazoria, TXTexas | $442.95 | $308.56 |
| Dallas, TXTexas | $446.13 | $311.06 |
| Fort Worth, TXTexas | $443.55 | $309.84 |
| Galveston, TXTexas | $444.51 | $309.85 |
| Houston, TXTexas | $455.86 | $321.20 |
| Rest of TexasTexas | $432.40 | $303.71 |
| UtahUtah | $429.74 | $302.27 |
| Virgin Islands, VIUnited States Virgin Islands | $451.72 | $314.62 |
| VermontVermont | $435.84 | $301.58 |
| Rest of WashingtonWashington | $460.90 | $318.10 |
| King County, WAWashington | $516.84 | $350.45 |
| WisconsinWisconsin | $422.64 | $292.73 |
| West VirginiaWest Virginia | $420.60 | $302.75 |
| WyomingWyoming | $443.52 | $307.92 |
42500 rates by state
Office rate range in each state. Select a state to see its payment localities.
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
| State / territory | Office rate range | Localities |
|---|---|---|
| AK | $530.06 | 1 |
| AL | $404.39 | 1 |
| AR | $398.79 | 1 |
| AZ | $437.11 | 1 |
| CA | $469.03–$580.77 | 29 |
| CO | $464.29 | 1 |
| CT | $478.02 | 1 |
| DC | $509.62 | 1 |
| DE | $444.13 | 1 |
| FL | $446.82–$492.23 | 3 |
| GA | $422.19–$458.05 | 2 |
| GU | $479.13 | 1 |
| HI | $479.13 | 1 |
| IA | $412.26 | 1 |
| ID | $415.26 | 1 |
| IL | $435.84–$478.15 | 4 |
| IN | $417.51 | 1 |
| KS | $411.35 | 1 |
| KY | $415.60 | 1 |
| LA | $415.35–$434.95 | 2 |
| MA | $462.07–$507.68 | 2 |
| MD | $452.06–$509.62 | 3 |
| ME | $418.34–$438.71 | 2 |
| MI | $426.85–$453.17 | 2 |
| MN | $442.57 | 1 |
| MO | $409.14–$435.31 | 3 |
| MS | $403.99 | 1 |
| MT | $448.87 | 1 |
| NC | $422.39 | 1 |
| ND | $436.61 | 1 |
| NE | $414.14 | 1 |
| NH | $457.97 | 1 |
| NJ | $482.83–$504.86 | 2 |
| NM | $429.48 | 1 |
| NV | $445.73 | 1 |
| NY | $428.55–$529.59 | 5 |
| OH | $424.34 | 1 |
| OK | $413.88 | 1 |
| OR | $441.62–$477.46 | 2 |
| PA | $424.46–$467.15 | 2 |
| PR | $451.72 | 1 |
| RI | $458.79 | 1 |
| SC | $424.20 | 1 |
| SD | $435.16 | 1 |
| TN | $413.45 | 1 |
| TX | $421.86–$463.32 | 8 |
| UT | $429.74 | 1 |
| VA | $437.99–$509.62 | 2 |
| VI | $451.72 | 1 |
| VT | $435.84 | 1 |
| WA | $460.90–$516.84 | 2 |
| WI | $422.64 | 1 |
| WV | $420.60 | 1 |
| WY | $443.52 | 1 |
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
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 Virginia 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
106
- Locality
- Virginia
- Physician work
- 1.000
- Practice expense
- 0.983
- Malpractice
- 0.706
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 4.31 | × 1.000 | 4.3100 |
| Practice expense | 8.51 | × 0.983 | 8.3653 |
| Malpractice | 0.62 | × 0.706 | 0.4377 |
| Total RVUs | 13.1130 | ||
| Conversion factor | × 33.4009 | ||
Office rate, Virginia$437.99
Office: (4.31 × 1 + 8.51 × 0.983 + 0.62 × 0.706) × $33.4009 = $437.99
Facility: (4.31 × 1 + 4.45 × 0.983 + 0.62 × 0.706) × $33.4009 = $304.69
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
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 090 | Major surgery: the day before, the day of, and 90 days after are included. |
| Multiple procedures | 2 | Standard reduction: highest-valued procedure at 100%, others at 50%. |
| Bilateral (modifier 50) | 0 | The 150% bilateral adjustment doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 0 | Not paid without supporting documentation. |
| Co-surgeons (62) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
| Split (54/55/56) | 0.09/0.81/0.10 | Share 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.
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%).
How 42500 has changed in Virginia
42500 · Office / nonfacility
$437.99
Effective 2026-10-01
The base rate is $8.65 higher than on 2025-10-01, moving from $429.34 to $437.99 (2.0%).
It is unchanged from the immediately preceding available release, effective 2026-07-01.
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
January 1, 2026
RVU26A
$429.34changed to$437.99
- 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 1.002 changed to 1.000
- Practice expense GPCI 0.984 changed to 0.983
- Malpractice GPCI 0.755 changed to 0.706
Held through RVU26B, RVU26C, RVU26D.
January 1, 2025
RVU25A
$443.47changed to$429.34
- Conversion factor 33.2875 changed to 32.3465
- Practice expense RVU 8.57 changed to 8.52
Held through RVU25B, RVU25C, RVU25D.
March 9, 2024
RVU24AR
$436.23changed to$443.47
- Conversion factor 32.7442 changed to 33.2875
Held through RVU24B, RVU24C, RVU24D.
January 1, 2024
RVU24A
$454.48changed to$436.23
- 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 1.000 changed to 1.002
- Practice expense GPCI 0.990 changed to 0.984
- Malpractice GPCI 0.826 changed to 0.755
January 1, 2023
RVU23A
$461.86changed to$454.48
- 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
- Practice expense GPCI 0.995 changed to 0.990
- Malpractice GPCI 0.897 changed to 0.826
Held through RVU23B, RVU23C, RVU23D.
January 1, 2022
RVU22A
$459.12changed to$461.86
- 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.
January 1, 2021
RVU21A
$445.97changed to$459.12
- 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
- Practice expense GPCI 0.991 changed to 0.995
- Malpractice GPCI 0.903 changed to 0.897
Held through RVU21B, RVU21C, RVU21D.
January 1, 2020
RVU20A
$444.23changed to$445.97
- 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 0.986 changed to 0.991
- Malpractice GPCI 0.908 changed to 0.903
Held through RVU20B, RVU20C, RVU20D.
January 1, 2019
RVU19A
$439.13changed to$444.23
- Conversion factor 35.9996 changed to 36.0391
- Practice expense RVU 7.29 changed to 7.42
Held through RVU19B, RVU19C, RVU19D.
January 1, 2018
RVU18AR1
$441.13changed to$439.13
- Conversion factor 35.8887 changed to 35.9996
- Practice expense RVU 7.42 changed to 7.29
- Practice expense GPCI 0.985 changed to 0.986
- Malpractice GPCI 0.866 changed to 0.908
Held through RVU18B, RVU18C, RVU18D.
January 1, 2017
RVU17A
$443.10changed to$441.13
- 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 0.983 changed to 0.985
- Malpractice GPCI 0.824 changed to 0.866
Held through RVU17B, RVU17C, RVU17D.
January 1, 2016
RVU16A
$443.17changed to$443.10
- 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.
July 1, 2015
RVU15C
$440.97changed to$443.17
- Conversion factor 35.7547 changed to 35.9335
Held through RVU15D.
January 1, 2015
RVU15A
$441.73changed to$440.97
- 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 0.980 changed to 0.983
- Malpractice GPCI 0.778 changed to 0.824
Held through RVU15B.
January 1, 2014
RVU14A
$443.53changed to$441.73
- 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 0.977 changed to 0.980
- Malpractice GPCI 0.731 changed to 0.778
Held through RVU14B, RVU14C, RVU14D.
January 1, 2013
RVU13AR
Earliest loaded release: $443.53
Held through RVU13B, RVU13C, RVU13D.
| Effective from | Office | Facility | CMS release |
|---|---|---|---|
| 2026-10-01 | $437.99 | $304.69 | RVU26D |
| 2026-07-01 | $437.99 | $304.69 | RVU26C |
| 2026-04-01 | $437.99 | $304.69 | RVU26B |
| 2026-01-01 | $437.99 | $304.69 | RVU26A |
| 2025-10-01 | $429.34 | $332.58 | RVU25D |
| 2025-07-01 | $429.34 | $332.58 | RVU25C |
| 2025-04-01 | $429.34 | $332.58 | RVU25B |
| 2025-01-01 | $429.34 | $332.58 | RVU25A |
| 2024-10-01 | $443.47 | $340.94 | RVU24D |
| 2024-07-01 | $443.47 | $340.94 | RVU24C |
| 2024-04-01 | $443.47 | $340.94 | RVU24B |
| 2024-03-09 | $443.47 | $340.94 | RVU24AR |
| 2024-01-01 | $436.23 | $335.38 | RVU24A |
| 2023-10-01 | $454.48 | $347.79 | RVU23D |
| 2023-07-01 | $454.48 | $347.79 | RVU23C |
| 2023-04-01 | $454.48 | $347.79 | RVU23B |
| 2023-01-01 | $454.48 | $347.79 | RVU23A |
| 2022-10-01 | $461.86 | $352.01 | RVU22D |
| 2022-07-01 | $461.86 | $352.01 | RVU22C |
| 2022-04-01 | $461.86 | $352.01 | RVU22B |
| 2022-01-01 | $461.86 | $352.01 | RVU22A |
| 2021-10-01 | $459.12 | $350.11 | RVU21D |
| 2021-07-01 | $459.12 | $350.11 | RVU21C |
| 2021-04-01 | $459.12 | $350.11 | RVU21B |
| 2021-01-01 | $459.12 | $350.11 | RVU21A |
| 2020-10-01 | $445.97 | $346.90 | RVU20D |
| 2020-07-01 | $445.97 | $346.90 | RVU20C |
| 2020-04-01 | $445.97 | $346.90 | RVU20B |
| 2020-01-01 | $445.97 | $346.90 | RVU20A |
| 2019-10-01 | $444.23 | $348.64 | RVU19D |
| 2019-07-01 | $444.23 | $348.64 | RVU19C |
| 2019-04-01 | $444.23 | $348.64 | RVU19B |
| 2019-01-01 | $444.23 | $348.64 | RVU19A |
| 2018-10-01 | $439.13 | $347.55 | RVU18D |
| 2018-07-01 | $439.13 | $347.55 | RVU18C |
| 2018-04-01 | $439.13 | $347.55 | RVU18B |
| 2018-01-01 | $439.13 | $347.55 | RVU18AR1 |
| 2017-10-01 | $441.13 | $349.22 | RVU17D |
| 2017-07-01 | $441.13 | $349.22 | RVU17C |
| 2017-04-01 | $441.13 | $349.22 | RVU17B |
| 2017-01-01 | $441.13 | $349.22 | RVU17A |
| 2016-10-01 | $443.10 | $350.89 | RVU16D |
| 2016-07-01 | $443.10 | $350.89 | RVU16C |
| 2016-04-01 | $443.10 | $350.89 | RVU16B |
| 2016-01-01 | $443.10 | $350.89 | RVU16A |
| 2015-10-01 | $443.17 | $350.63 | RVU15D |
| 2015-07-01 | $443.17 | $350.63 | RVU15C |
| 2015-04-01 | $440.97 | $348.88 | RVU15B |
| 2015-01-01 | $440.97 | $348.88 | RVU15A |
| 2014-10-01 | $441.73 | $349.75 | RVU14D |
| 2014-07-01 | $441.73 | $349.75 | RVU14C |
| 2014-04-01 | $441.73 | $349.75 | RVU14B |
| 2014-01-01 | $441.73 | $349.75 | RVU14A |
| 2013-10-01 | $443.53 | $346.80 | RVU13D |
| 2013-07-01 | $443.53 | $346.80 | RVU13C |
| 2013-04-01 | $443.53 | $346.80 | RVU13B |
| 2013-01-01 | $443.53 | $346.80 | RVU13AR |
Where the Virginia rate applies
Virginia is a Medicare payment area, not a city. Our Census mapping connects it to 628 cities and communities in Virginia. Some span more than one payment area; confirm with the service ZIP.
- Abbs Valley
- Abingdon
- Accomac
- Adwolf
- Afton
- Alberta
- Aldie
- Allison Gap
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
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