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CPT code 42505: Salivary duct repair, secondary, complicated2026 Medicare rate & RVUs in Washington, DC area

Reports complex secondary reconstruction of a salivary duct, such as repair of a scarred or injured duct when a simple primary procedure is insufficient.

CMS RVU26DEffective Oct 1, 2026One payment locality282 Medicare services in 2024

In Washington, DC area, Medicare pays $648.90 for 42505 in the office and $455.71 when it’s performed in a hospital or facility.

$648.90Office (non-facility)
$455.71Hospital or facility
+13.0%vs the national office rate ($574.16)

Check a contract rate as a % of Medicare · 42505 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 42505 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in Washington, DC area
  2. What 42505 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 42505 covers

This service involves complex reconstruction of a salivary duct after an earlier procedure, injury, or disease has left the duct damaged or scarred. The surgeon restores duct continuity or function through a secondary repair; the work may involve reconstructing or repositioning the duct. Otolaryngologists and oral and maxillofacial surgeons typically perform it in an operating room, including for parotid or other major salivary duct problems.

Choose this code when the operative work is a complicated secondary repair, rather than a simple primary duct procedure. Document the reason for secondary reconstruction, the condition of the duct, and the repair performed. The day-before preoperative visit and related postoperative care through day 90 are included in the global period. When other 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. Medicare does not pay an assistant at surgery for this service under the statutory restriction; 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 Washington, DC area compares for 42505

Across 109 of 109 payment localities, the office rate for 42505 runs from $511.87 in Arkansas to $732.40 in San Benito County, CA. Washington, DC area pays $648.90. The RVUs are the same everywhere; the geographic indexes change the dollars.

42505 in Washington, DC area vs other payment areas
  1. Washington, DC area · this page$648.90
  2. Los Angeles, CA · California$634.42−$14.48
  3. Miami, FL · Florida$634.00−$14.90
  4. Chicago, IL · Illinois$616.22−$32.68
  5. Manhattan, NY · New York$659.76+$10.86
  6. Alaska · Alaska$685.53+$36.63
  7. Alabama · Alabama$518.82−$130.08

Other areas in District of Columbia first, then benchmark localities. Bars start at $0.

Every other payment area

42505 in every other Medicare payment locality
Payment localityOfficeFacility
ArkansasArkansas$511.87$371.00
ArizonaArizona$559.34$400.43
Bakersfield, CACalifornia$598.80$419.06
Chico, CACalifornia$596.19$416.45
El Centro, CACalifornia$596.34$416.60
Fresno, CACalifornia$596.19$416.45
Hanford, CACalifornia$596.19$416.45
Madera, CACalifornia$596.19$416.45

42505 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.

$511.87

$685.53

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

View every state and territory as a table
42505 office rate range by state
State / territoryOffice rate rangeLocalities
AK$685.531
AL$518.821
AR$511.871
AZ$559.341
CA$596.19–$732.4029
CO$591.701
CT$610.641
DC$648.901
DE$568.091
FL$574.39–$634.003
GA$543.39–$586.232
GU$607.861
HI$607.861
IA$527.271
ID$531.251
IL$561.65–$616.224
IN$534.011
KS$526.771
KY$534.051
LA$533.99–$558.292
MA$589.28–$644.932
MD$577.81–$648.903
ME$535.73–$560.022
MI$548.60–$582.942
MN$562.811
MO$526.69–$557.983
MS$519.281
MT$574.101
NC$540.641
ND$556.311
NE$529.411
NH$584.281
NJ$616.44–$643.302
NM$552.121
NV$569.481
NY$548.32–$677.045
OH$544.971
OK$531.251
OR$563.88–$607.312
PA$544.76–$597.542
PR$577.431
RI$585.991
SC$543.941
SD$554.201
TN$529.451
TX$541.58–$590.778
UT$550.791
VA$559.57–$648.902
VI$577.431
VT$555.931
WA$587.58–$655.752
WI$539.151
WV$542.791
WY$566.351

See 42505 in every payment locality

How the 42505 rate is calculated

Each of 42505’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 · 42505

RVUs × geographic indexes × conversion factor

Office or facility?

Work6.16

6.16 RVUs× 1.000 GPCI

Practice expense10.13

10.13 RVUs× 1.000 GPCI

Malpractice0.90

0.90 RVUs× 1.000 GPCI

Adjusted RVUs

17.1900

Conversion factor

$33.4009

Medicare rate

$574.16

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

The exact Washington, DC area inputs and CMS source lines

PPRRVU2026_Oct_nonQPP.csv

5,043

Code
42505
Physician work
6.16
Practice expense
10.13
Malpractice
0.90

GPCI2026.csv

39

Locality
Washington, DC area
Physician work
1.054
Practice expense
1.178
Malpractice
1.113
Office calculation for 42505 in Washington, DC area
ComponentRVULocality factorAdjusted
Physician work6.16× 1.0546.4926
Practice expense10.13× 1.17811.9331
Malpractice0.90× 1.1131.0017
Total RVUs19.4275
Conversion factor× 33.4009

Office rate, Washington, DC area$648.90

Office: (6.16 × 1.054 + 10.13 × 1.178 + 0.9 × 1.113) × $33.4009 = $648.90

Facility: (6.16 × 1.054 + 5.22 × 1.178 + 0.9 × 1.113) × $33.4009 = $455.71

Open 42505 in the RVU calculator

Payment rules and modifiers for 42505

42505 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 42505

Salivary duct repair, secondary, complicated

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)1Not paid (statutory restriction).
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 · 42505

Salivary duct repair, secondary, complicated

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

42505 without 51 · national office

$574.16

Salivary duct repair, secondary, complicated

42505-51 · Second procedure: 50%

$287.08

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 42505

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

Codes related to 42505
CodeHow it relatesOffice range, Washington, DC area
Same family
42500Duct repair, salivary ductSimple primary salivary duct procedure; distinguish it from this code's complicated secondary repair.$509.62
Used instead
42507Parotid duct diversion, bilateral procedureA parotid duct transposition procedure when the operative goal is duct relocation rather than secondary repair.No office rate
42509Parotid duct diversion, bilateralA parotid duct diversion procedure; select according to the diversion performed, not a complicated secondary repair.No office rate
42510Parotid duct diversion, bilateral duct reroutingA parotid duct diversion procedure for a different operative objective than secondary duct repair.No office rate

How 42505 has changed in Washington, DC area

42505 · Office / nonfacility

$648.90

Effective 2026-10-01

The base rate is $8.60 higher than on 2025-10-01, moving from $640.30 to $648.90 (1.3%).

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

    $640.30changed to$648.90

    • Conversion factor 32.3465 changed to 33.4009
    • Work RVU 6.32 changed to 6.16
    • Practice expense RVU 10.14 changed to 10.13
    • Malpractice RVU 0.88 changed to 0.90
    • Work GPCI 1.057 changed to 1.054
    • Practice expense GPCI 1.192 changed to 1.178
    • Malpractice GPCI 1.168 changed to 1.113

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $662.47changed to$640.30

    • Conversion factor 33.2875 changed to 32.3465
    • Practice expense RVU 10.20 changed to 10.14
    • Malpractice RVU 0.91 changed to 0.88

    Held through RVU25B, RVU25C, RVU25D.

  3. March 9, 2024

    RVU24AR

    $651.66changed to$662.47

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $681.26changed to$651.66

    • Conversion factor 33.8872 changed to 32.7442
    • Practice expense RVU 10.16 changed to 10.20
    • Malpractice RVU 0.89 changed to 0.91
    • Work GPCI 1.056 changed to 1.057
    • Practice expense GPCI 1.214 changed to 1.192
    • Malpractice GPCI 1.231 changed to 1.168

  5. January 1, 2023

    RVU23A

    $695.97changed to$681.26

    • Conversion factor 34.6062 changed to 33.8872
    • Practice expense RVU 9.95 changed to 10.16
    • Work GPCI 1.054 changed to 1.056
    • Practice expense GPCI 1.236 changed to 1.214
    • Malpractice GPCI 1.294 changed to 1.231

    Held through RVU23B, RVU23C, RVU23D.

  6. January 1, 2022

    RVU22A

    $687.45changed to$695.97

    • Conversion factor 34.8931 changed to 34.6062
    • Practice expense RVU 9.65 changed to 9.95
    • Malpractice RVU 0.86 changed to 0.89

    Held through RVU22B, RVU22C, RVU22D.

  7. January 1, 2021

    RVU21A

    $667.97changed to$687.45

    • Conversion factor 36.0896 changed to 34.8931
    • Practice expense RVU 8.84 changed to 9.65
    • Malpractice RVU 0.85 changed to 0.86
    • Work GPCI 1.049 changed to 1.054
    • Practice expense GPCI 1.221 changed to 1.236
    • Malpractice GPCI 1.277 changed to 1.294

    Held through RVU21B, RVU21C, RVU21D.

  8. January 1, 2020

    RVU20A

    $659.81changed to$667.97

    • Conversion factor 36.0391 changed to 36.0896
    • Practice expense RVU 8.75 changed to 8.84
    • Malpractice RVU 0.92 changed to 0.85
    • Work GPCI 1.045 changed to 1.049
    • Practice expense GPCI 1.205 changed to 1.221
    • Malpractice GPCI 1.261 changed to 1.277

    Held through RVU20B, RVU20C, RVU20D.

  9. January 1, 2019

    RVU19A

    $651.70changed to$659.81

    • Conversion factor 35.9996 changed to 36.0391
    • Practice expense RVU 8.59 changed to 8.75
    • Malpractice RVU 0.91 changed to 0.92

    Held through RVU19B, RVU19C, RVU19D.

  10. January 1, 2018

    RVU18AR1

    $657.18changed to$651.70

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 8.74 changed to 8.59
    • Work GPCI 1.048 changed to 1.045
    • Malpractice GPCI 1.271 changed to 1.261

    Held through RVU18B, RVU18C, RVU18D.

  11. January 1, 2017

    RVU17A

    $664.86changed to$657.18

    • Conversion factor 35.8043 changed to 35.8887
    • Practice expense RVU 8.91 changed to 8.74
    • Malpractice RVU 0.93 changed to 0.91
    • Work GPCI 1.051 changed to 1.048
    • Malpractice GPCI 1.280 changed to 1.271

    Held through RVU17B, RVU17C, RVU17D.

  12. January 1, 2016

    RVU16A

    $665.12changed to$664.86

    • Conversion factor 35.9335 changed to 35.8043
    • Practice expense RVU 8.85 changed to 8.91
    • Malpractice RVU 0.94 changed to 0.93

    Held through RVU16B, RVU16C, RVU16D.

  13. July 1, 2015

    RVU15C

    $661.81changed to$665.12

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  14. January 1, 2015

    RVU15A

    $661.07changed to$661.81

    • Conversion factor 35.8228 changed to 35.7547
    • Practice expense RVU 9.06 changed to 8.85
    • Malpractice RVU 0.77 changed to 0.94
    • Work GPCI 1.050 changed to 1.051
    • Practice expense GPCI 1.202 changed to 1.205
    • Malpractice GPCI 1.205 changed to 1.280

    Held through RVU15B.

  15. January 1, 2014

    RVU14A

    $662.28changed to$661.07

    • Conversion factor 34.0230 changed to 35.8228
    • Practice expense RVU 9.96 changed to 9.06
    • Malpractice RVU 0.80 changed to 0.77
    • Work GPCI 1.049 changed to 1.050
    • Practice expense GPCI 1.198 changed to 1.202
    • Malpractice GPCI 1.130 changed to 1.205

    Held through RVU14B, RVU14C, RVU14D.

  16. January 1, 2013

    RVU13AR

    Earliest loaded release: $662.28

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$648.90$455.71RVU26D
2026-07-01$648.90$455.71RVU26C
2026-04-01$648.90$455.71RVU26B
2026-01-01$648.90$455.71RVU26A
2025-10-01$640.30$507.66RVU25D
2025-07-01$640.30$507.66RVU25C
2025-04-01$640.30$507.66RVU25B
2025-01-01$640.30$507.66RVU25A
2024-10-01$662.47$522.41RVU24D
2024-07-01$662.47$522.41RVU24C
2024-04-01$662.47$522.41RVU24B
2024-03-09$662.47$522.41RVU24AR
2024-01-01$651.66$513.88RVU24A
2023-10-01$681.26$535.22RVU23D
2023-07-01$681.26$535.22RVU23C
2023-04-01$681.26$535.22RVU23B
2023-01-01$681.26$535.22RVU23A
2022-10-01$695.97$544.98RVU22D
2022-07-01$695.97$544.98RVU22C
2022-04-01$695.97$544.98RVU22B
2022-01-01$695.97$544.98RVU22A
2021-10-01$687.45$538.22RVU21D
2021-07-01$687.45$538.22RVU21C
2021-04-01$687.45$538.22RVU21B
2021-01-01$687.45$538.22RVU21A
2020-10-01$667.97$531.81RVU20D
2020-07-01$667.97$531.81RVU20C
2020-04-01$667.97$531.81RVU20B
2020-01-01$667.97$531.81RVU20A
2019-10-01$659.81$529.53RVU19D
2019-07-01$659.81$529.53RVU19C
2019-04-01$659.81$529.53RVU19B
2019-01-01$659.81$529.53RVU19A
2018-10-01$651.70$526.33RVU18D
2018-07-01$651.70$526.33RVU18C
2018-04-01$651.70$526.33RVU18B
2018-01-01$651.70$526.33RVU18AR1
2017-10-01$657.18$531.77RVU17D
2017-07-01$657.18$531.77RVU17C
2017-04-01$657.18$531.77RVU17B
2017-01-01$657.18$531.77RVU17A
2016-10-01$664.86$538.45RVU16D
2016-07-01$664.86$538.45RVU16C
2016-04-01$664.86$538.45RVU16B
2016-01-01$664.86$538.45RVU16A
2015-10-01$665.12$537.82RVU15D
2015-07-01$665.12$537.82RVU15C
2015-04-01$661.81$535.14RVU15B
2015-01-01$661.81$535.14RVU15A
2014-10-01$661.07$534.48RVU14D
2014-07-01$661.07$534.48RVU14C
2014-04-01$661.07$534.48RVU14B
2014-01-01$661.07$534.48RVU14A
2013-10-01$662.28$528.59RVU13D
2013-07-01$662.28$528.59RVU13C
2013-04-01$662.28$528.59RVU13B
2013-01-01$662.28$528.59RVU13AR

Price 42505 for an earlier date of service

Where the Washington, DC area rate applies

Washington, DC area is a Medicare payment area, not a city. Our Census mapping connects it to 1 cities and communities in District of Columbia. Some span more than one payment area; confirm with the service ZIP.

  • Washington

Browse all communities in District of Columbia

42505 billing questions

How does this differ from 42500?

Use 42505 for a complicated secondary repair, such as reconstruction of a previously treated or scarred duct. Code 42500 describes a simple primary duct procedure.

Is postoperative care separately reportable?

Related postoperative care through day 90 is included in the global period, along with the day-before preoperative visit.

Can modifier 50 be used?

No. The descriptor and anatomy make modifier 50 inappropriate for this code.

Can an assistant surgeon or co-surgeon be reported?

Medicare does not pay an assistant at surgery for this service under the statutory restriction. Co-surgeons and team surgery are not permitted.

How is this paid with another procedure in the same session?

The highest-valued procedure is paid in full; other procedures in the same session are subject to the standard 50% multiple-procedure reduction.

What documentation supports choosing 42505?

Describe why secondary reconstruction was needed, the duct's condition, and the operative repair. The record should support complicated secondary work rather than a simple primary procedure.

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 42505PPRRVU2026_Oct_nonQPP.csv, line 5,043 (RVU26D)
Geographic factors for Washington, DC areaGPCI2026.csv, line 39 (RVU26D)

Open CMS sourceHow we calculate rates

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