CPT code 42650: Salivary duct dilation, percutaneous approach2026 Medicare rate & RVUs in California
Percutaneous salivary duct dilation widens a narrowed duct through a skin approach, typically to address impaired salivary drainage from duct stenosis.
Medicare pays $80.16–$99.13 for 42650 in the office in California, from Chico, CA to San Benito County, CA. 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.
Your location
On this page 9 sections
What 42650 covers
This service widens a narrowed salivary duct using a percutaneous approach. It may be performed when duct stenosis interferes with saliva drainage, such as in a patient with obstructive salivary symptoms. Otolaryngologists and other surgeons who treat salivary duct disorders typically perform it in an office procedure setting or a facility, depending on the case and practice arrangement. The route matters: dilation performed through the mouth is represented by a different code.
Report the service when the physician performs percutaneous duct dilation, and document the treated duct, the access route, the narrowing or drainage problem, and the work performed. The code has a 0-day global period, so same-day preoperative and postoperative care is included. 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 multiple-procedure reduction. Modifier 50 is inappropriate for this code. Medicare does not pay an assistant at surgery, and 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 42650 pays more and less in California
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
29 payment localities
$80.16 to $99.13
29 of 29 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Bakersfield, CA | $80.48 | $54.85 |
| Chico, CA | $80.16 | $54.54 |
| El Centro, CA | $80.18 | $54.55 |
| Fresno, CA | $80.16 | $54.54 |
| Hanford, CA | $80.16 | $54.54 |
| Los Angeles, CA | $85.42 | $57.76 |
| Madera, CA | $80.16 | $54.54 |
| Marin County, CA | $96.93 | $63.97 |
| Merced, CA | $80.16 | $54.54 |
| Modesto, CA | $80.16 | $54.54 |
| Napa, CA | $91.89 | $61.07 |
| Oxnard, CA | $84.89 | $57.26 |
| Redding, CA | $80.16 | $54.54 |
| Rest of California | $80.16 | $54.54 |
| Riverside, CA | $81.35 | $55.73 |
| Sacramento, CA | $83.86 | $56.67 |
| Salinas, CA | $83.54 | $56.44 |
| San Benito County, CA | $99.13 | $65.42 |
| San Diego, CA | $85.32 | $57.35 |
| San Francisco, CA | $96.81 | $63.84 |
| San Luis Obispo, CA | $82.23 | $55.60 |
| Santa Clara County, CA | $98.62 | $64.91 |
| Santa Cruz, CA | $85.98 | $57.58 |
| Santa Maria, CA | $83.80 | $56.54 |
| Santa Rosa, CA | $86.83 | $58.12 |
| Stockton, CA | $80.16 | $54.54 |
| Vallejo, CA | $91.71 | $60.89 |
| Visalia, CA | $80.16 | $54.54 |
| Yuba City, CA | $80.16 | $54.54 |
How the 42650 rate is calculated
Each of 42650’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 · 42650
RVUs × geographic indexes × conversion factor
Work0.75
0.75 RVUs× 1.000 GPCI
Practice expense1.44
1.44 RVUs× 1.000 GPCI
Malpractice0.11
0.11 RVUs× 1.000 GPCI
Adjusted RVUs
2.3000
Conversion factor
$33.4009
Medicare rate
$76.82
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 42650
The CMS indicators that decide how 42650 is paid alongside other services.
CMS payment indicators · 42650
Salivary duct dilation, percutaneous approach
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 000 | Same-day global: pre- and post-op care on the day of the procedure is 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. |
What modifiers do to the payment
Modifier 51 · payment effect
With and without the modifier
42650 without 51 · national office
$76.82
Salivary duct dilation, percutaneous approach
42650-51 · Second procedure: 50%
$38.41
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%).
42650 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 42660Salivary duct dilationComplicated procedure
- The approach determines the choice: 42650 is for percutaneous duct dilation, while 42660 is for dilation through the mouth.
- 42600Fistula closureSalivary tract
- 42600 addresses closure of a salivary fistula. It does not represent widening a narrowed duct.
- 42665Salivary duct surgeryDuct interruption
- 42665 represents salivary duct ligation, a different procedure from dilation intended to widen a narrowed duct.
42650 billing questions
How is this code distinguished from 42660?
Choose 42650 for a percutaneous approach to dilating the salivary duct. Code 42660 represents dilation performed through an intraoral approach.
What documentation supports reporting this service?
Document the duct treated, the percutaneous route, the stenosis or drainage problem, and the dilation performed.
Is modifier 50 appropriate when both sides are treated?
No. The CMS bilateral adjustment does not apply, and modifier 50 is inappropriate for this code.
Can an assistant surgeon or co-surgeon be reported?
Medicare does not pay an assistant at surgery for this service. Co-surgeons and team surgery are not permitted.
How are other procedures in the same session paid?
When multiple procedures are performed in one session, the highest-valued procedure is paid in full and the others are subject to the standard multiple-procedure reduction.
Does the code include same-day postoperative care?
Yes. The 0-day global period includes same-day preoperative and postoperative care.
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
Fee sheets
Put 42650 and the rest of your codes on one sheet
Your codes at your locality, with payer contracts beside Medicare.
Build my fee sheet