CPT code 42600: Fistula closure, salivary tract2026 Medicare rate & RVUs in Missouri
Surgical closure of an abnormal salivary tract, such as persistent leakage from a salivary gland or duct to the skin or oral surface.
Medicare pays $489.82–$522.43 for 42600 in the office in Missouri, from Rest of Missouri to Metropolitan St. Louis, MO. Which amount applies depends on the service address.
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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On this page 9 sections
What 42600 covers
This operation closes an abnormal tract through which saliva escapes from a salivary gland or duct, such as a persistent opening from a parotid-region fistula to the skin. An otolaryngologist, head and neck surgeon, or oral and maxillofacial surgeon may perform the repair, typically in an operating room. The surgeon identifies the fistulous tract and surgically closes it; this is distinct from simply dilating or ligating a salivary duct.
Report 42600 when the operative service is closure of the salivary fistula. The operative report should identify the fistula’s location and salivary source, describe the closure performed, and distinguish it from a duct repair or ligation. CMS assigns a 90-day global period, including the day-before preoperative visit and related postoperative care. When multiple procedures occur 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. 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 42600 pays more and less in Missouri
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
3 payment localities
$489.82 to $522.43
| Payment locality | Office | Facility |
|---|---|---|
| Metropolitan Kansas City, MO | $517.23 | $310.54 |
| Metropolitan St. Louis, MO | $522.43 | $312.88 |
| Rest of Missouri | $489.82 | $300.08 |
How the 42600 rate is calculated
Each of 42600’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 · 42600
RVUs × geographic indexes × conversion factor
Work4.82
4.82 RVUs× 1.000 GPCI
Practice expense10.63
10.63 RVUs× 1.000 GPCI
Malpractice0.70
0.70 RVUs× 1.000 GPCI
Adjusted RVUs
16.1500
Conversion factor
$33.4009
Medicare rate
$539.42
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 42600
42600 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 42600
Fistula closure, salivary tract
| 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 · 42600
Fistula closure, salivary tract
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
42600 without 51 · national office
$539.42
Fistula closure, salivary tract
42600-51 · Second procedure: 50%
$269.71
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%).
42600 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 42500Duct repairSalivary duct
- 42500 describes suturing a salivary duct. Choose 42600 when the operative target is closure of an abnormal salivary fistula.
- 42505Salivary duct repairSecondary, complicated
- 42505 is for repair of the salivary duct itself; 42600 is for surgically closing a fistulous tract.
- 42665Salivary duct surgeryDuct interruption
- 42665 describes salivary duct ligation. It differs from 42600, which closes the fistula rather than ligating the duct.
- 42650Salivary duct dilationPercutaneous approach
- 42650 describes dilation of a salivary duct, not closure of a salivary fistula.
42600 billing questions
How is fistula closure different from salivary duct repair?
Use 42600 when the procedure closes an abnormal tract leaking saliva. Codes for duct repair describe repair of the duct itself, rather than closure of a fistula.
Is modifier 50 appropriate for bilateral fistula closure?
No. CMS identifies bilateral adjustment as inappropriate for this code.
What postoperative care is included?
The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.
When may an assistant-at-surgery be paid?
Payment is allowed only when the record documents medical necessity for the assistant.
Can co-surgeons or a surgical team be reported?
CMS does not permit co-surgeon or team-surgery payment for this code.
How is 42600 affected when other procedures are performed in the same session?
Under the standard multiple-procedure reduction, the highest-valued procedure is paid in full and the other procedures are paid at 50%.
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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