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

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 Virginia, Medicare pays $526.51 for 42600 in the office and $310.14 when it’s performed in a hospital or facility.

$526.51Office (non-facility)
$310.14Hospital or facility
−2.4%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 Virginia
  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 Virginia 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. Virginia pays $526.51. The RVUs are the same everywhere; the geographic indexes change the dollars.

42600 in Virginia vs other payment areas
  1. Virginia · this page$526.51
  2. Los Angeles, CA · California$603.14+$76.63
  3. Washington, DC area · District of Columbia$613.96+$87.45
  4. Miami, FL · Florida$589.73+$63.22
  5. Chicago, IL · Illinois$572.60+$46.09
  6. Manhattan, NY · New York$620.95+$94.44
  7. Alaska · Alaska$632.50+$105.99

Other areas in Virginia 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.

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.

$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 Virginia 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

106

Locality
Virginia
Physician work
1.000
Practice expense
0.983
Malpractice
0.706
Office calculation for 42600 in Virginia
ComponentRVULocality factorAdjusted
Physician work4.82× 1.0004.8200
Practice expense10.63× 0.98310.4493
Malpractice0.70× 0.7060.4942
Total RVUs15.7635
Conversion factor× 33.4009

Office rate, Virginia$526.51

Office: (4.82 × 1 + 10.63 × 0.983 + 0.7 × 0.706) × $33.4009 = $526.51

Facility: (4.82 × 1 + 4.04 × 0.983 + 0.7 × 0.706) × $33.4009 = $310.14

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

Codes related to 42600

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

Codes related to 42600
CodeHow it relatesOffice range, Virginia
Used instead
42500Duct repair, salivary ductSuture of a salivary duct is a duct procedure, rather than closure of a fistulous tract.$437.99
42505Salivary duct repair, secondary, complicatedRepair of a salivary duct addresses the duct itself, not a salivary fistula.$559.57
42665Salivary duct surgery, duct interruptionLigation of a salivary duct is a different operative approach from closing a fistula.$360.09
42699Salivary procedure, unlisted procedureUnlisted salivary gland or duct procedure code for a service without a specific CPT code.No office rate

How 42600 has changed in Virginia

42600 · Office / nonfacility

$526.51

Effective 2026-10-01

The base rate is $9.44 higher than on 2025-10-01, moving from $517.07 to $526.51 (1.8%).

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

    $517.07changed to$526.51

    • 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
    • Work GPCI 1.002 changed to 1.000
    • Practice expense GPCI 0.984 changed to 0.983
    • Malpractice GPCI 0.755 changed to 0.706

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $538.25changed to$517.07

    • 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

    $529.47changed to$538.25

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $552.62changed to$529.47

    • 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
    • Work GPCI 1.000 changed to 1.002
    • Practice expense GPCI 0.990 changed to 0.984
    • Malpractice GPCI 0.826 changed to 0.755

  5. January 1, 2023

    RVU23A

    $562.50changed to$552.62

    • 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
    • Practice expense GPCI 0.995 changed to 0.990
    • Malpractice GPCI 0.897 changed to 0.826

    Held through RVU23B, RVU23C, RVU23D.

  6. January 1, 2022

    RVU22A

    $547.79changed to$562.50

    • 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

    $520.63changed to$547.79

    • 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
    • Practice expense GPCI 0.991 changed to 0.995
    • Malpractice GPCI 0.903 changed to 0.897

    Held through RVU21B, RVU21C, RVU21D.

  8. January 1, 2020

    RVU20A

    $503.31changed to$520.63

    • 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
    • Practice expense GPCI 0.986 changed to 0.991
    • Malpractice GPCI 0.908 changed to 0.903

    Held through RVU20B, RVU20C, RVU20D.

  9. January 1, 2019

    RVU19A

    $483.24changed to$503.31

    • 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

    $478.84changed to$483.24

    • Conversion factor 35.8887 changed to 35.9996
    • Malpractice RVU 0.66 changed to 0.71
    • Practice expense GPCI 0.985 changed to 0.986
    • Malpractice GPCI 0.866 changed to 0.908

    Held through RVU18B, RVU18C, RVU18D.

  11. January 1, 2017

    RVU17A

    $488.54changed to$478.84

    • 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
    • Practice expense GPCI 0.983 changed to 0.985
    • Malpractice GPCI 0.824 changed to 0.866

    Held through RVU17B, RVU17C, RVU17D.

  12. January 1, 2016

    RVU16A

    $488.77changed to$488.54

    • 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

    $486.34changed to$488.77

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  14. January 1, 2015

    RVU15A

    $487.10changed to$486.34

    • 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
    • Practice expense GPCI 0.980 changed to 0.983
    • Malpractice GPCI 0.778 changed to 0.824

    Held through RVU15B.

  15. January 1, 2014

    RVU14A

    $491.47changed to$487.10

    • 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
    • Practice expense GPCI 0.977 changed to 0.980
    • Malpractice GPCI 0.731 changed to 0.778

    Held through RVU14B, RVU14C, RVU14D.

  16. January 1, 2013

    RVU13AR

    Earliest loaded release: $491.47

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$526.51$310.14RVU26D
2026-07-01$526.51$310.14RVU26C
2026-04-01$526.51$310.14RVU26B
2026-01-01$526.51$310.14RVU26A
2025-10-01$517.07$342.96RVU25D
2025-07-01$517.07$342.96RVU25C
2025-04-01$517.07$342.96RVU25B
2025-01-01$517.07$342.96RVU25A
2024-10-01$538.25$351.88RVU24D
2024-07-01$538.25$351.88RVU24C
2024-04-01$538.25$351.88RVU24B
2024-03-09$538.25$351.88RVU24AR
2024-01-01$529.47$346.14RVU24A
2023-10-01$552.62$357.70RVU23D
2023-07-01$552.62$357.70RVU23C
2023-04-01$552.62$357.70RVU23B
2023-01-01$552.62$357.70RVU23A
2022-10-01$562.50$360.72RVU22D
2022-07-01$562.50$360.72RVU22C
2022-04-01$562.50$360.72RVU22B
2022-01-01$562.50$360.72RVU22A
2021-10-01$547.79$355.44RVU21D
2021-07-01$547.79$355.44RVU21C
2021-04-01$547.79$355.44RVU21B
2021-01-01$547.79$355.44RVU21A
2020-10-01$520.63$356.83RVU20D
2020-07-01$520.63$356.83RVU20C
2020-04-01$520.63$356.83RVU20B
2020-01-01$520.63$356.83RVU20A
2019-10-01$503.31$356.20RVU19D
2019-07-01$503.31$356.20RVU19C
2019-04-01$503.31$356.20RVU19B
2019-01-01$503.31$356.20RVU19A
2018-10-01$483.24$352.26RVU18D
2018-07-01$483.24$352.26RVU18C
2018-04-01$483.24$352.26RVU18B
2018-01-01$483.24$352.26RVU18AR1
2017-10-01$478.84$350.16RVU17D
2017-07-01$478.84$350.16RVU17C
2017-04-01$478.84$350.16RVU17B
2017-01-01$478.84$350.16RVU17A
2016-10-01$488.54$355.85RVU16D
2016-07-01$488.54$355.85RVU16C
2016-04-01$488.54$355.85RVU16B
2016-01-01$488.54$355.85RVU16A
2015-10-01$488.77$355.25RVU15D
2015-07-01$488.77$355.25RVU15C
2015-04-01$486.34$353.48RVU15B
2015-01-01$486.34$353.48RVU15A
2014-10-01$487.10$354.05RVU14D
2014-07-01$487.10$354.05RVU14C
2014-04-01$487.10$354.05RVU14B
2014-01-01$487.10$354.05RVU14A
2013-10-01$491.47$350.19RVU13D
2013-07-01$491.47$350.19RVU13C
2013-04-01$491.47$350.19RVU13B
2013-01-01$491.47$350.19RVU13AR

Price 42600 for an earlier date of service

Where the Virginia rate applies

Virginia is a Medicare payment area, not a city. Our Census mapping connects it to 628 cities and communities in Virginia. Some span more than one payment area; confirm with the service ZIP.

  • Abbs Valley
  • Abingdon
  • Accomac
  • Adwolf
  • Afton
  • Alberta
  • Aldie
  • Allison Gap

Browse all communities in Virginia

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 VirginiaGPCI2026.csv, line 106 (RVU26D)

Open CMS sourceHow we calculate rates

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