CPT code 42600: Fistula closure, salivary tract2026 Medicare rate & RVUs in South Dakota

Surgical closure of an abnormal salivary tract, such as persistent leakage from a salivary gland or duct to the skin or oral surface.

CMS RVU26DEffective Oct 1, 2026One payment locality15 Medicare services in 2024

In South Dakota, Medicare pays $523.90 for 42600 in the office and $303.79 when it’s performed in a hospital or facility.

$523.90Office (non-facility)
$303.79Hospital or facility
−2.9%vs the national office rate ($539.42)

Check a contract rate as a % of Medicare · 42600 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 42600 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in South Dakota
  2. What 42600 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 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.

How South Dakota compares for 42600

Across 109 of 109 payment localities, the office rate for 42600 runs from $478.02 in Arkansas to $703.22 in San Benito County, CA. South Dakota pays $523.90. The RVUs are the same everywhere; the geographic indexes change the dollars.

42600 in South Dakota vs other payment areas
  1. South Dakota · this page$523.90
  2. Los Angeles, CA · California$603.14+$79.24
  3. Washington, DC area · District of Columbia$613.96+$90.06
  4. Miami, FL · Florida$589.73+$65.83
  5. Chicago, IL · Illinois$572.60+$48.70
  6. Manhattan, NY · New York$620.95+$97.05
  7. Alaska · Alaska$632.50+$108.60

Other areas in South Dakota first, then benchmark localities. Bars start at $0.

Every other payment area

42600 in every other Medicare payment locality
Payment localityOfficeFacility
AlabamaAlabama$484.90$292.30
ArkansasArkansas$478.02$288.95
ArizonaArizona$525.05$311.76
Bakersfield, CACalifornia$567.43$326.18
Chico, CACalifornia$565.40$324.16
El Centro, CACalifornia$565.51$324.27
Fresno, CACalifornia$565.40$324.16
Hanford, CACalifornia$565.40$324.16

42600 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.

$478.02

$634.31

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

View every state and territory as a table
42600 office rate range by state
State / territoryOffice rate rangeLocalities
AK$632.501
AL$484.901
AR$478.021
AZ$525.051
CA$565.40–$703.2229
CO$558.961
CT$574.891
DC$613.961
DE$533.611
FL$535.56–$589.733
GA$505.57–$550.292
GU$578.221
HI$578.221
IA$495.151
ID$498.701
IL$521.70–$572.604
IN$501.491
KS$493.741
KY$498.031
LA$497.61–$521.662
MA$556.07–$612.332
MD$543.38–$613.963
ME$502.18–$527.602
MI$511.55–$543.042
MN$533.261
MO$489.82–$522.433
MS$483.971
MT$539.381
NC$507.201
ND$525.541
NE$497.541
NH$551.061
NJ$580.80–$607.972
NM$514.651
NV$535.881
NY$514.73–$636.875
OH$508.721
OK$496.221
OR$531.06–$575.432
PA$509.02–$561.392
PR$542.981
RI$551.671
SC$508.931
SD$523.901
TN$496.291
TX$505.81–$557.678
UT$515.741
VA$526.51–$613.962
VI$542.981
VT$524.321
WA$554.75–$623.792
WI$508.331
WV$502.991
WY$533.351

See 42600 in every payment locality

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

Office or facility?

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.

The exact South Dakota inputs and CMS source lines

PPRRVU2026_Oct_nonQPP.csv

5,051

Code
42600
Physician work
4.82
Practice expense
10.63
Malpractice
0.70

GPCI2026.csv

94

Locality
South Dakota
Physician work
1.000
Practice expense
1.000
Malpractice
0.336
Office calculation for 42600 in South Dakota
ComponentRVULocality factorAdjusted
Physician work4.82× 1.0004.8200
Practice expense10.63× 1.00010.6300
Malpractice0.70× 0.3360.2352
Total RVUs15.6852
Conversion factor× 33.4009

Office rate, South Dakota$523.90

Office: (4.82 × 1 + 10.63 × 1 + 0.7 × 0.336) × $33.4009 = $523.90

Facility: (4.82 × 1 + 4.04 × 1 + 0.7 × 0.336) × $33.4009 = $303.79

Open 42600 in the RVU calculator

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

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)0Not paid without supporting documentation.
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 · 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.

  • 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

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%).

When to use modifier 51

How 42600 has changed in South Dakota

42600 · Office / nonfacility

$523.90

Effective 2026-10-01

The base rate is $10.20 higher than on 2025-10-01, moving from $513.70 to $523.90 (2.0%).

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

    $513.70changed to$523.90

    • Conversion factor 32.3465 changed to 33.4009
    • Work RVU 4.94 changed to 4.82
    • Practice expense RVU 10.67 changed to 10.63
    • Malpractice RVU 0.71 changed to 0.70
    • Malpractice GPCI 0.382 changed to 0.336

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $534.77changed to$513.70

    • Conversion factor 33.2875 changed to 32.3465
    • Practice expense RVU 10.85 changed to 10.67
    • Malpractice RVU 0.72 changed to 0.71

    Held through RVU25B, RVU25C, RVU25D.

  3. March 9, 2024

    RVU24AR

    $526.04changed to$534.77

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $545.19changed to$526.04

    • Conversion factor 33.8872 changed to 32.7442
    • Practice expense RVU 10.89 changed to 10.85
    • Malpractice RVU 0.71 changed to 0.72
    • Malpractice GPCI 0.364 changed to 0.382
  5. January 1, 2023

    RVU23A

    $551.03changed to$545.19

    • Conversion factor 34.6062 changed to 33.8872
    • Practice expense RVU 10.74 changed to 10.89
    • Malpractice RVU 0.70 changed to 0.71
    • Malpractice GPCI 0.347 changed to 0.364

    Held through RVU23B, RVU23C, RVU23D.

  6. January 1, 2022

    RVU22A

    $536.51changed to$551.03

    • Conversion factor 34.8931 changed to 34.6062
    • Practice expense RVU 10.20 changed to 10.74
    • Malpractice RVU 0.68 changed to 0.70

    Held through RVU22B, RVU22C, RVU22D.

  7. January 1, 2021

    RVU21A

    $511.00changed to$536.51

    • Conversion factor 36.0896 changed to 34.8931
    • Practice expense RVU 8.98 changed to 10.20
    • Malpractice RVU 0.65 changed to 0.68
    • Malpractice GPCI 0.368 changed to 0.347

    Held through RVU21B, RVU21C, RVU21D.

  8. January 1, 2020

    RVU20A

    $494.32changed to$511.00

    • Conversion factor 36.0391 changed to 36.0896
    • Practice expense RVU 8.50 changed to 8.98
    • Malpractice RVU 0.71 changed to 0.65
    • Malpractice GPCI 0.389 changed to 0.368

    Held through RVU20B, RVU20C, RVU20D.

  9. January 1, 2019

    RVU19A

    $473.98changed to$494.32

    • Conversion factor 35.9996 changed to 36.0391
    • Practice expense RVU 7.95 changed to 8.50

    Held through RVU19B, RVU19C, RVU19D.

  10. January 1, 2018

    RVU18AR1

    $471.96changed to$473.98

    • Conversion factor 35.8887 changed to 35.9996
    • Malpractice RVU 0.66 changed to 0.71
    • Malpractice GPCI 0.395 changed to 0.389

    Held through RVU18B, RVU18C, RVU18D.

  11. January 1, 2017

    RVU17A

    $482.79changed to$471.96

    • Conversion factor 35.8043 changed to 35.8887
    • Practice expense RVU 8.26 changed to 7.95
    • Malpractice RVU 0.71 changed to 0.66
    • Malpractice GPCI 0.400 changed to 0.395

    Held through RVU17B, RVU17C, RVU17D.

  12. January 1, 2016

    RVU16A

    $482.66changed to$482.79

    • Conversion factor 35.9335 changed to 35.8043
    • Practice expense RVU 8.20 changed to 8.26
    • Malpractice RVU 0.73 changed to 0.71

    Held through RVU16B, RVU16C, RVU16D.

  13. July 1, 2015

    RVU15C

    $480.26changed to$482.66

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  14. January 1, 2015

    RVU15A

    $485.18changed to$480.26

    • Conversion factor 35.8228 changed to 35.7547
    • Practice expense RVU 8.35 changed to 8.20
    • Malpractice RVU 0.61 changed to 0.73
    • Malpractice GPCI 0.416 changed to 0.400

    Held through RVU15B.

  15. January 1, 2014

    RVU14A

    $492.19changed to$485.18

    • Conversion factor 34.0230 changed to 35.8228
    • Practice expense RVU 9.25 changed to 8.35
    • Malpractice RVU 0.64 changed to 0.61
    • Malpractice GPCI 0.432 changed to 0.416

    Held through RVU14B, RVU14C, RVU14D.

  16. January 1, 2013

    RVU13AR

    Earliest loaded release: $492.19

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$523.90$303.79RVU26D
2026-07-01$523.90$303.79RVU26C
2026-04-01$523.90$303.79RVU26B
2026-01-01$523.90$303.79RVU26A
2025-10-01$513.70$336.77RVU25D
2025-07-01$513.70$336.77RVU25C
2025-04-01$513.70$336.77RVU25B
2025-01-01$513.70$336.77RVU25A
2024-10-01$534.77$345.36RVU24D
2024-07-01$534.77$345.36RVU24C
2024-04-01$534.77$345.36RVU24B
2024-03-09$534.77$345.36RVU24AR
2024-01-01$526.04$339.72RVU24A
2023-10-01$545.19$348.31RVU23D
2023-07-01$545.19$348.31RVU23C
2023-04-01$545.19$348.31RVU23B
2023-01-01$545.19$348.31RVU23A
2022-10-01$551.03$348.24RVU22D
2022-07-01$551.03$348.24RVU22C
2022-04-01$551.03$348.24RVU22B
2022-01-01$551.03$348.24RVU22A
2021-10-01$536.51$343.21RVU21D
2021-07-01$536.51$343.21RVU21C
2021-04-01$536.51$343.21RVU21B
2021-01-01$536.51$343.21RVU21A
2020-10-01$511.00$345.71RVU20D
2020-07-01$511.00$345.71RVU20C
2020-04-01$511.00$345.71RVU20B
2020-01-01$511.00$345.71RVU20A
2019-10-01$494.32$345.12RVU19D
2019-07-01$494.32$345.12RVU19C
2019-04-01$494.32$345.12RVU19B
2019-01-01$494.32$345.12RVU19A
2018-10-01$473.98$341.14RVU18D
2018-07-01$473.98$341.14RVU18C
2018-04-01$473.98$341.14RVU18B
2018-01-01$473.98$341.14RVU18AR1
2017-10-01$471.96$341.33RVU17D
2017-07-01$471.96$341.33RVU17C
2017-04-01$471.96$341.33RVU17B
2017-01-01$471.96$341.33RVU17A
2016-10-01$482.79$347.80RVU16D
2016-07-01$482.79$347.80RVU16C
2016-04-01$482.79$347.80RVU16B
2016-01-01$482.79$347.80RVU16A
2015-10-01$482.66$346.83RVU15D
2015-07-01$482.66$346.83RVU15C
2015-04-01$480.26$345.10RVU15B
2015-01-01$480.26$345.10RVU15A
2014-10-01$485.18$349.41RVU14D
2014-07-01$485.18$349.41RVU14C
2014-04-01$485.18$349.41RVU14B
2014-01-01$485.18$349.41RVU14A
2013-10-01$492.19$347.60RVU13D
2013-07-01$492.19$347.60RVU13C
2013-04-01$492.19$347.60RVU13B
2013-01-01$492.19$347.60RVU13AR

Price 42600 for an earlier date of service

Where the South Dakota rate applies

South Dakota is a Medicare payment area, not a city. Our Census mapping connects it to 485 cities and communities in South Dakota. Some span more than one payment area; confirm with the service ZIP.

  • Aberdeen
  • Agar
  • Agency Village
  • Akaska
  • Albee
  • Alcester
  • Alexandria
  • Allen

Browse all communities in South Dakota

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
RVUs for 42600PPRRVU2026_Oct_nonQPP.csv, line 5,051 (RVU26D)
Geographic factors for South DakotaGPCI2026.csv, line 94 (RVU26D)

Open CMS sourceHow we calculate rates

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