CPT code 42505: Salivary duct repair, secondary, complicated2026 Medicare rate & RVUs in New Hampshire
Reports complex secondary reconstruction of a salivary duct, such as repair of a scarred or injured duct when a simple primary procedure is insufficient.
In New Hampshire, Medicare pays $584.28 for 42505 in the office and $413.55 when it’s performed in a hospital or facility.
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.
On this page 11 sections
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 New Hampshire 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. New Hampshire pays $584.28. The RVUs are the same everywhere; the geographic indexes change the dollars.
- New Hampshire · this page$584.28
- Los Angeles, CA · California$634.42+$50.14
- Washington, DC area · District of Columbia$648.90+$64.62
- Miami, FL · Florida$634.00+$49.72
- Chicago, IL · Illinois$616.22+$31.94
- Manhattan, NY · New York$659.76+$75.48
- Alaska · Alaska$685.53+$101.25
Other areas in New Hampshire first, then benchmark localities. Bars start at $0.
Every other payment area
| Payment locality | Office | Facility |
|---|---|---|
| AlabamaAlabama | $518.82 | $375.32 |
| 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 |
| Merced, CACalifornia | $596.19 | $416.45 |
| Modesto, CACalifornia | $596.19 | $416.45 |
| Napa, CACalifornia | $679.93 | $463.78 |
| Oxnard, CACalifornia | $630.17 | $436.32 |
| Redding, CACalifornia | $596.19 | $416.45 |
| Rest of CaliforniaCalifornia | $596.19 | $416.45 |
| Riverside, CACalifornia | $605.93 | $426.19 |
| Sacramento, CACalifornia | $622.77 | $432.04 |
| Salinas, CACalifornia | $620.39 | $430.32 |
| San Diego, CACalifornia | $632.88 | $436.74 |
| Marin County, CACalifornia | $716.17 | $484.93 |
| San Francisco, CACalifornia | $715.15 | $483.91 |
| San Benito County, CACalifornia | $732.40 | $495.91 |
| Santa Clara County, CACalifornia | $728.22 | $491.73 |
| San Luis Obispo, CACalifornia | $610.74 | $423.95 |
| Santa Cruz, CACalifornia | $637.28 | $438.02 |
| Santa Maria, CACalifornia | $622.14 | $430.92 |
| Santa Rosa, CACalifornia | $643.53 | $442.14 |
| Stockton, CACalifornia | $596.19 | $416.45 |
| Vallejo, CACalifornia | $678.46 | $462.31 |
| Visalia, CACalifornia | $596.19 | $416.45 |
| Yuba City, CACalifornia | $596.19 | $416.45 |
| ColoradoColorado | $591.70 | $417.21 |
| ConnecticutConnecticut | $610.64 | $434.02 |
| DelawareDelaware | $568.09 | $406.06 |
| Fort Lauderdale, FLFlorida | $602.85 | $436.72 |
| Rest of FloridaFlorida | $574.39 | $417.61 |
| Atlanta, GAGeorgia | $586.23 | $419.61 |
| Rest of GeorgiaGeorgia | $543.39 | $397.10 |
| Hawaii, Guam, HIHawaii | $607.86 | $421.39 |
| IowaIowa | $527.27 | $377.22 |
| IdahoIdaho | $531.25 | $380.37 |
| East St. Louis, ILIllinois | $577.58 | $426.70 |
| Rest of IllinoisIllinois | $561.65 | $411.92 |
| Suburban Chicago, ILIllinois | $607.94 | $439.52 |
| IndianaIndiana | $534.01 | $381.98 |
| KansasKansas | $526.77 | $378.52 |
| KentuckyKentucky | $534.05 | $388.25 |
| New Orleans, LALouisiana | $558.29 | $403.96 |
| Rest of LouisianaLouisiana | $533.99 | $388.85 |
| Metropolitan Boston, MAMassachusetts | $644.93 | $449.12 |
| Rest of MassachusettsMassachusetts | $589.28 | $416.59 |
| Baltimore area, MDMaryland | $609.28 | $433.31 |
| Rest of MarylandMaryland | $577.81 | $411.85 |
| Rest of MaineMaine | $535.73 | $384.85 |
| Southern Maine, MEMaine | $560.02 | $397.50 |
| Detroit, MIMichigan | $582.94 | $424.68 |
| Rest of MichiganMichigan | $548.60 | $398.87 |
| MinnesotaMinnesota | $562.81 | $394.06 |
| Metropolitan Kansas City, MOMissouri | $552.83 | $398.84 |
| Metropolitan St. Louis, MOMissouri | $557.98 | $401.85 |
| Rest of MissouriMissouri | $526.69 | $385.32 |
| MississippiMississippi | $519.28 | $378.08 |
| MontanaMontana | $574.10 | $410.10 |
| North CarolinaNorth Carolina | $540.64 | $387.63 |
| North DakotaNorth Dakota | $556.31 | $392.31 |
| NebraskaNebraska | $529.41 | $378.04 |
| Northern New JerseyNew Jersey | $643.30 | $453.07 |
| Rest of New JerseyNew Jersey | $616.44 | $437.35 |
| New MexicoNew Mexico | $552.12 | $401.73 |
| NevadaNevada | $569.48 | $405.32 |
| NYC suburbs and Long Island, NYNew York | $677.04 | $482.05 |
| Poughkeepsie and northern NYC suburbs, NYNew York | $621.88 | $442.30 |
| Queens, NYNew York | $662.20 | $468.35 |
| Rest of New YorkNew York | $548.32 | $392.52 |
| OhioOhio | $544.97 | $395.23 |
| OklahomaOklahoma | $531.25 | $384.80 |
| Portland, OROregon | $607.31 | $425.11 |
| Rest of OregonOregon | $563.88 | $400.54 |
| Metropolitan Philadelphia, PAPennsylvania | $597.54 | $426.82 |
| Rest of PennsylvaniaPennsylvania | $544.76 | $394.21 |
| Puerto RicoPuerto Rico | $577.43 | $411.63 |
| Rhode IslandRhode Island | $585.99 | $416.58 |
| South CarolinaSouth Carolina | $543.94 | $392.40 |
| South DakotaSouth Dakota | $554.20 | $390.20 |
| TennesseeTennessee | $529.45 | $380.38 |
| Austin, TXTexas | $590.77 | $417.26 |
| Beaumont, TXTexas | $541.58 | $392.34 |
| Brazoria, TXTexas | $566.15 | $403.63 |
| Dallas, TXTexas | $570.39 | $407.05 |
| Fort Worth, TXTexas | $567.40 | $405.70 |
| Galveston, TXTexas | $568.27 | $405.42 |
| Houston, TXTexas | $584.74 | $421.89 |
| Rest of TexasTexas | $553.99 | $398.36 |
| UtahUtah | $550.79 | $396.64 |
| VirginiaVirginia | $559.57 | $398.36 |
| Virgin Islands, VIUnited States Virgin Islands | $577.43 | $411.63 |
| VermontVermont | $555.93 | $393.57 |
| Rest of WashingtonWashington | $587.58 | $414.89 |
| King County, WAWashington | $655.75 | $454.53 |
| WisconsinWisconsin | $539.15 | $382.04 |
| West VirginiaWest Virginia | $542.79 | $400.28 |
| WyomingWyoming | $566.35 | $402.35 |
42505 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.
$511.87
$685.53
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 | $685.53 | 1 |
| AL | $518.82 | 1 |
| AR | $511.87 | 1 |
| AZ | $559.34 | 1 |
| CA | $596.19–$732.40 | 29 |
| CO | $591.70 | 1 |
| CT | $610.64 | 1 |
| DC | $648.90 | 1 |
| DE | $568.09 | 1 |
| FL | $574.39–$634.00 | 3 |
| GA | $543.39–$586.23 | 2 |
| GU | $607.86 | 1 |
| HI | $607.86 | 1 |
| IA | $527.27 | 1 |
| ID | $531.25 | 1 |
| IL | $561.65–$616.22 | 4 |
| IN | $534.01 | 1 |
| KS | $526.77 | 1 |
| KY | $534.05 | 1 |
| LA | $533.99–$558.29 | 2 |
| MA | $589.28–$644.93 | 2 |
| MD | $577.81–$648.90 | 3 |
| ME | $535.73–$560.02 | 2 |
| MI | $548.60–$582.94 | 2 |
| MN | $562.81 | 1 |
| MO | $526.69–$557.98 | 3 |
| MS | $519.28 | 1 |
| MT | $574.10 | 1 |
| NC | $540.64 | 1 |
| ND | $556.31 | 1 |
| NE | $529.41 | 1 |
| NH | $584.28 | 1 |
| NJ | $616.44–$643.30 | 2 |
| NM | $552.12 | 1 |
| NV | $569.48 | 1 |
| NY | $548.32–$677.04 | 5 |
| OH | $544.97 | 1 |
| OK | $531.25 | 1 |
| OR | $563.88–$607.31 | 2 |
| PA | $544.76–$597.54 | 2 |
| PR | $577.43 | 1 |
| RI | $585.99 | 1 |
| SC | $543.94 | 1 |
| SD | $554.20 | 1 |
| TN | $529.45 | 1 |
| TX | $541.58–$590.77 | 8 |
| UT | $550.79 | 1 |
| VA | $559.57–$648.90 | 2 |
| VI | $577.43 | 1 |
| VT | $555.93 | 1 |
| WA | $587.58–$655.75 | 2 |
| WI | $539.15 | 1 |
| WV | $542.79 | 1 |
| WY | $566.35 | 1 |
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
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 New Hampshire 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
74
- Locality
- New Hampshire
- Physician work
- 1.000
- Practice expense
- 1.041
- Malpractice
- 0.875
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 6.16 | × 1.000 | 6.1600 |
| Practice expense | 10.13 | × 1.041 | 10.5453 |
| Malpractice | 0.90 | × 0.875 | 0.7875 |
| Total RVUs | 17.4928 | ||
| Conversion factor | × 33.4009 | ||
Office rate, New Hampshire$584.28
Office: (6.16 × 1 + 10.13 × 1.041 + 0.9 × 0.875) × $33.4009 = $584.28
Facility: (6.16 × 1 + 5.22 × 1.041 + 0.9 × 0.875) × $33.4009 = $413.55
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
| 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) | 1 | Not paid (statutory restriction). |
| 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 · 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.
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%).
How 42505 has changed in New Hampshire
42505 · Office / nonfacility
$584.28
Effective 2026-10-01
The base rate is $15.14 higher than on 2025-10-01, moving from $569.14 to $584.28 (2.7%).
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
$569.14changed to$584.28
- 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
- Practice expense GPCI 1.034 changed to 1.041
- Malpractice GPCI 0.898 changed to 0.875
Held through RVU26B, RVU26C, RVU26D.
January 1, 2025
RVU25A
$588.66changed to$569.14
- 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.
March 9, 2024
RVU24AR
$579.05changed to$588.66
- Conversion factor 32.7442 changed to 33.2875
Held through RVU24B, RVU24C, RVU24D.
January 1, 2024
RVU24A
$598.21changed to$579.05
- 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
- Practice expense GPCI 1.036 changed to 1.034
- Malpractice GPCI 0.907 changed to 0.898
January 1, 2023
RVU23A
$604.37changed to$598.21
- Conversion factor 34.6062 changed to 33.8872
- Practice expense RVU 9.95 changed to 10.16
- Practice expense GPCI 1.038 changed to 1.036
- Malpractice GPCI 0.917 changed to 0.907
Held through RVU23B, RVU23C, RVU23D.
January 1, 2022
RVU22A
$597.56changed to$604.37
- 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.
January 1, 2021
RVU21A
$590.70changed to$597.56
- 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
- Practice expense GPCI 1.042 changed to 1.038
- Malpractice GPCI 0.984 changed to 0.917
Held through RVU21B, RVU21C, RVU21D.
January 1, 2020
RVU20A
$592.11changed to$590.70
- 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
- Practice expense GPCI 1.045 changed to 1.042
- Malpractice GPCI 1.050 changed to 0.984
Held through RVU20B, RVU20C, RVU20D.
January 1, 2019
RVU19A
$585.07changed to$592.11
- 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.
January 1, 2018
RVU18AR1
$588.21changed to$585.07
- Conversion factor 35.8887 changed to 35.9996
- Practice expense RVU 8.74 changed to 8.59
- Practice expense GPCI 1.052 changed to 1.045
- Malpractice GPCI 0.962 changed to 1.050
Held through RVU18B, RVU18C, RVU18D.
January 1, 2017
RVU17A
$592.87changed to$588.21
- 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
- Practice expense GPCI 1.058 changed to 1.052
- Malpractice GPCI 0.873 changed to 0.962
Held through RVU17B, RVU17C, RVU17D.
January 1, 2016
RVU16A
$593.04changed to$592.87
- 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.
July 1, 2015
RVU15C
$590.09changed to$593.04
- Conversion factor 35.7547 changed to 35.9335
Held through RVU15D.
January 1, 2015
RVU15A
$591.42changed to$590.09
- 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
- Practice expense GPCI 1.051 changed to 1.058
- Malpractice GPCI 0.867 changed to 0.873
Held through RVU15B.
January 1, 2014
RVU14A
No ratechanged to$591.42
Held through RVU14B, RVU14C, RVU14D.
January 1, 2013
RVU13AR
Earliest loaded release: No rate
Held through RVU13B, RVU13C, RVU13D.
| Effective from | Office | Facility | CMS release |
|---|---|---|---|
| 2026-10-01 | $584.28 | $413.55 | RVU26D |
| 2026-07-01 | $584.28 | $413.55 | RVU26C |
| 2026-04-01 | $584.28 | $413.55 | RVU26B |
| 2026-01-01 | $584.28 | $413.55 | RVU26A |
| 2025-10-01 | $569.14 | $454.08 | RVU25D |
| 2025-07-01 | $569.14 | $454.08 | RVU25C |
| 2025-04-01 | $569.14 | $454.08 | RVU25B |
| 2025-01-01 | $569.14 | $454.08 | RVU25A |
| 2024-10-01 | $588.66 | $467.16 | RVU24D |
| 2024-07-01 | $588.66 | $467.16 | RVU24C |
| 2024-04-01 | $588.66 | $467.16 | RVU24B |
| 2024-03-09 | $588.66 | $467.16 | RVU24AR |
| 2024-01-01 | $579.05 | $459.53 | RVU24A |
| 2023-10-01 | $598.21 | $473.58 | RVU23D |
| 2023-07-01 | $598.21 | $473.58 | RVU23C |
| 2023-04-01 | $598.21 | $473.58 | RVU23B |
| 2023-01-01 | $598.21 | $473.58 | RVU23A |
| 2022-10-01 | $604.37 | $477.57 | RVU22D |
| 2022-07-01 | $604.37 | $477.57 | RVU22C |
| 2022-04-01 | $604.37 | $477.57 | RVU22B |
| 2022-01-01 | $604.37 | $477.57 | RVU22A |
| 2021-10-01 | $597.56 | $472.24 | RVU21D |
| 2021-07-01 | $597.56 | $472.24 | RVU21C |
| 2021-04-01 | $597.56 | $472.24 | RVU21B |
| 2021-01-01 | $597.56 | $472.24 | RVU21A |
| 2020-10-01 | $590.70 | $474.50 | RVU20D |
| 2020-07-01 | $590.70 | $474.50 | RVU20C |
| 2020-04-01 | $590.70 | $474.50 | RVU20B |
| 2020-01-01 | $590.70 | $474.50 | RVU20A |
| 2019-10-01 | $592.11 | $479.13 | RVU19D |
| 2019-07-01 | $592.11 | $479.13 | RVU19C |
| 2019-04-01 | $592.11 | $479.13 | RVU19B |
| 2019-01-01 | $592.11 | $479.13 | RVU19A |
| 2018-10-01 | $585.07 | $476.35 | RVU18D |
| 2018-07-01 | $585.07 | $476.35 | RVU18C |
| 2018-04-01 | $585.07 | $476.35 | RVU18B |
| 2018-01-01 | $585.07 | $476.35 | RVU18AR1 |
| 2017-10-01 | $588.21 | $478.72 | RVU17D |
| 2017-07-01 | $588.21 | $478.72 | RVU17C |
| 2017-04-01 | $588.21 | $478.72 | RVU17B |
| 2017-01-01 | $588.21 | $478.72 | RVU17A |
| 2016-10-01 | $592.87 | $481.88 | RVU16D |
| 2016-07-01 | $592.87 | $481.88 | RVU16C |
| 2016-04-01 | $592.87 | $481.88 | RVU16B |
| 2016-01-01 | $592.87 | $481.88 | RVU16A |
| 2015-10-01 | $593.04 | $481.27 | RVU15D |
| 2015-07-01 | $593.04 | $481.27 | RVU15C |
| 2015-04-01 | $590.09 | $478.88 | RVU15B |
| 2015-01-01 | $590.09 | $478.88 | RVU15A |
| 2014-10-01 | $591.42 | $480.73 | RVU14D |
| 2014-07-01 | $591.42 | $480.73 | RVU14C |
| 2014-04-01 | $591.42 | $480.73 | RVU14B |
| 2014-01-01 | $591.42 | $480.73 | RVU14A |
| 2013-10-01 | Rate data unavailable | Rate data unavailable | RVU13D |
| 2013-07-01 | Rate data unavailable | Rate data unavailable | RVU13C |
| 2013-04-01 | Rate data unavailable | Rate data unavailable | RVU13B |
| 2013-01-01 | Rate data unavailable | Rate data unavailable | RVU13AR |
Where the New Hampshire rate applies
New Hampshire is a Medicare payment area, not a city. Our Census mapping connects it to 100 cities and communities in New Hampshire. Some span more than one payment area; confirm with the service ZIP.
- Alton
- Amherst
- Antrim
- Ashland
- Bartlett
- Belmont
- Bennington
- Berlin
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
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