CPT code 42509: Parotid duct diversion, bilateral2026 Medicare rate & RVUs in Texas
Reports surgery that redirects both parotid ducts, commonly to manage persistent drooling associated with neurologic or swallowing disorders.
CMS doesn’t publish an office rate for 42509 in Texas.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
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What 42509 covers
In bilateral parotid duct diversion, the surgeon reroutes the openings of both parotid ducts so saliva drains farther back in the mouth. Otolaryngologists and oral and maxillofacial surgeons may perform this operation for severe, persistent drooling, including in patients with neurologic conditions that impair saliva control. The service is performed in an operative setting and is distinct from repairing a damaged duct or injecting contrast to image the salivary system.
Report 42509 for the bilateral diversion service; the code is priced as bilateral, so modifier 50 does not increase payment. The operative report should establish that both parotid ducts were diverted and describe the work performed. The code has a 90-day global period, which 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% reduction. Assistant-at-surgery payment requires documented medical necessity; 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.
Where 42509 pays more and less in Texas
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
8 of 8 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Austin, TX | Unavailable | $729.43 |
| Beaumont, TX | Unavailable | $689.64 |
| Brazoria, TX | Unavailable | $707.06 |
| Dallas, TX | Unavailable | $713.20 |
| Fort Worth, TX | Unavailable | $711.12 |
| Galveston, TX | Unavailable | $710.30 |
| Houston, TX | Unavailable | $740.87 |
| Rest of Texas | Unavailable | $699.10 |
How the 42509 rate is calculated
Each of 42509’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 · 42509
RVUs × geographic indexes × conversion factor
Work11.47
11.47 RVUs× 1.000 GPCI
Practice expense8.38
8.38 RVUs× 1.000 GPCI
Malpractice1.67
1.67 RVUs× 1.000 GPCI
Adjusted RVUs
21.5200
Conversion factor
$33.4009
Medicare rate
$718.79
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 42509
42509 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 42509
Parotid duct diversion, bilateral
| 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) | 2 | Already bilateral by definition: paid once at 100%. |
| 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 · 42509
Parotid duct diversion, bilateral
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
42509 without 51 · national facility
$718.79
Parotid duct diversion, bilateral
42509-51 · Second procedure: 50%
$359.40
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%).
42509 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 42507Parotid duct diversionBilateral procedure
- Both codes concern parotid duct diversion. 42509 is priced as a bilateral service; use the code that matches the specific diversion performed and documented.
- 42510Parotid duct diversionBilateral duct rerouting
- This is another code with a parotid duct diversion descriptor. Check the full descriptor and operative details rather than treating it as interchangeable with bilateral 42509.
- 42500Duct repairSalivary duct
- 42500 reports salivary duct repair. Choose it when the surgeon repairs a duct rather than rerouting both parotid duct openings.
- 42505Salivary duct repairSecondary, complicated
- 42505 is for a more involved salivary duct repair, not bilateral diversion of the parotid ducts.
42509 billing questions
When should 42509 be chosen over 42507?
Use 42509 when the operative service diverts both parotid ducts. The related 42507 code is another parotid duct diversion code; select based on the specific procedure documented and the applicable code descriptor.
Should modifier 50 be appended?
No. 42509 is already priced as bilateral, and modifier 50 does not increase payment.
What documentation supports reporting 42509?
The operative report should identify diversion of both parotid ducts and describe the surgical work. Documentation of drooling or a neurologic condition alone does not establish that the bilateral diversion was performed.
Are related postoperative visits included?
Yes. The 90-day 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 is available only when medical necessity is documented. Co-surgeons and team surgery are not permitted for this code.
How does the multiple-procedure reduction affect 42509?
When it is performed with other procedures in the same session, the highest-valued procedure is paid in full and the other procedures are subject to the standard 50% reduction.
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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