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CPT code 42650: Salivary duct dilation, percutaneous approach2026 Medicare rate & RVUs in Los Angeles, CA

Percutaneous salivary duct dilation widens a narrowed duct through a skin approach, typically to address impaired salivary drainage from duct stenosis.

CMS RVU26DEffective Oct 1, 2026One payment locality429 Medicare services in 2024

In Los Angeles, CA, Medicare pays $85.42 for 42650 in the office and $57.76 when it’s performed in a hospital or facility.

$85.42Office (non-facility)
$57.76Hospital or facility
+11.2%vs the national office rate ($76.82)

Check a contract rate as a % of Medicare · 42650 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 42650 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in Los Angeles, CA
  2. What 42650 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 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.

How Los Angeles, CA compares for 42650

Across 109 of 109 payment localities, the office rate for 42650 runs from $68.26 in Arkansas to $99.13 in San Benito County, CA. Los Angeles, CA pays $85.42. The RVUs are the same everywhere; the geographic indexes change the dollars.

42650 in Los Angeles, CA vs other payment areas
  1. Los Angeles, CA · this page$85.42
  2. Bakersfield, CA · California$80.48−$4.94
  3. Chico, CA · California$80.16−$5.26
  4. El Centro, CA · California$80.18−$5.24
  5. Fresno, CA · California$80.16−$5.26
  6. Hanford, CA · California$80.16−$5.26
  7. Madera, CA · California$80.16−$5.26

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

Every other payment area

42650 in every other Medicare payment locality
Payment localityOfficeFacility
Merced, CACalifornia$80.16$54.54
Modesto, CACalifornia$80.16$54.54
Napa, CACalifornia$91.89$61.07
Oxnard, CACalifornia$84.89$57.26
Redding, CACalifornia$80.16$54.54
Rest of CaliforniaCalifornia$80.16$54.54
Riverside, CACalifornia$81.35$55.73
Sacramento, CACalifornia$83.86$56.67

42650 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.

$68.26

$90.82

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

View every state and territory as a table
42650 office rate range by state
State / territoryOffice rate rangeLocalities
AK$90.821
AL$69.221
AR$68.261
AZ$74.801
CA$80.16–$99.1329
CO$79.401
CT$81.801
DC$87.151
DE$76.001
FL$76.55–$84.413
GA$72.33–$78.412
GU$81.861
HI$81.861
IA$70.521
ID$71.041
IL$74.71–$82.004
IN$71.421
KS$70.381
KY$71.171
LA$71.14–$74.482
MA$79.03–$86.782
MD$77.35–$87.153
ME$71.59–$75.032
MI$73.11–$77.662
MN$75.631
MO$70.09–$74.523
MS$69.181
MT$76.811
NC$72.271
ND$74.641
NE$70.831
NH$78.331
NJ$82.61–$86.352
NM$73.571
NV$76.261
NY$73.33–$90.665
OH$72.671
OK$70.861
OR$75.54–$81.622
PA$72.68–$79.952
PR$77.301
RI$78.491
SC$72.621
SD$74.381
TN$70.741
TX$72.23–$79.248
UT$73.561
VA$74.92–$87.152
VI$77.301
VT$74.531
WA$78.82–$88.322
WI$72.261
WV$72.101
WY$75.871

See 42650 in every payment locality

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

Office or facility?

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.

The exact Los Angeles, CA inputs and CMS source lines

PPRRVU2026_Oct_nonQPP.csv

5,054

Code
42650
Physician work
0.75
Practice expense
1.44
Malpractice
0.11

GPCI2026.csv

13

Locality
Los Angeles, CA
Physician work
1.041
Practice expense
1.183
Malpractice
0.664
Office calculation for 42650 in Los Angeles, CA
ComponentRVULocality factorAdjusted
Physician work0.75× 1.0410.7807
Practice expense1.44× 1.1831.7035
Malpractice0.11× 0.6640.0730
Total RVUs2.5573
Conversion factor× 33.4009

Office rate, Los Angeles, CA$85.42

Office: (0.75 × 1.041 + 1.44 × 1.183 + 0.11 × 0.664) × $33.4009 = $85.42

Facility: (0.75 × 1.041 + 0.74 × 1.183 + 0.11 × 0.664) × $33.4009 = $57.76

Open 42650 in the RVU calculator

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

RuleCMS valueWhat it means
Global period000Same-day global: pre- and post-op care on the day of the procedure is 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)1Not paid (statutory restriction).
Co-surgeons (62)0Not permitted.
Team surgery (66)0Not permitted.
Professional/technical0Physician 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%).

When to use modifier 51

Codes related to 42650

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

Codes related to 42650
CodeHow it relatesOffice range, Los Angeles, CA
Same family
42660Salivary duct dilation, complicated procedureSalivary duct dilation through an intraoral rather than percutaneous approach.$112.92
42600Fistula closure, salivary tractRelated salivary duct surgery code for closure of a fistula, not duct dilation.$603.14
Used instead
42699Salivary procedure, unlisted procedureUse for a salivary gland or duct procedure when no specific code describes the service.No office rate

How 42650 has changed in Los Angeles, CA

42650 · Office / nonfacility

$85.42

Effective 2026-10-01

The base rate is $4.26 higher than on 2025-10-01, moving from $81.16 to $85.42 (5.2%).

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

    $81.16changed to$85.42

    • Conversion factor 32.3465 changed to 33.4009
    • Work RVU 0.77 changed to 0.75
    • Practice expense RVU 1.36 changed to 1.44
    • Malpractice RVU 0.12 changed to 0.11
    • Work GPCI 1.042 changed to 1.041
    • Practice expense GPCI 1.194 changed to 1.183
    • Malpractice GPCI 0.690 changed to 0.664

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $83.69changed to$81.16

    • Conversion factor 33.2875 changed to 32.3465
    • Practice expense RVU 1.37 changed to 1.36
    • Malpractice RVU 0.11 changed to 0.12

    Held through RVU25B, RVU25C, RVU25D.

  3. March 9, 2024

    RVU24AR

    $82.32changed to$83.69

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $84.98changed to$82.32

    • Conversion factor 33.8872 changed to 32.7442
    • Work GPCI 1.045 changed to 1.042
    • Practice expense GPCI 1.185 changed to 1.194
    • Malpractice GPCI 0.724 changed to 0.690

  5. January 1, 2023

    RVU23A

    $85.70changed to$84.98

    • Conversion factor 34.6062 changed to 33.8872
    • Practice expense RVU 1.35 changed to 1.37
    • Work GPCI 1.048 changed to 1.045
    • Practice expense GPCI 1.175 changed to 1.185
    • Malpractice GPCI 0.757 changed to 0.724

    Held through RVU23B, RVU23C, RVU23D.

  6. January 1, 2022

    RVU22A

    $88.46changed to$85.70

    • Conversion factor 34.8931 changed to 34.6062
    • Practice expense RVU 1.40 changed to 1.35

    Held through RVU22B, RVU22C, RVU22D.

  7. January 1, 2021

    RVU21A

    $90.12changed to$88.46

    • Conversion factor 36.0896 changed to 34.8931
    • Practice expense RVU 1.37 changed to 1.40
    • Work GPCI 1.047 changed to 1.048
    • Practice expense GPCI 1.176 changed to 1.175
    • Malpractice GPCI 0.725 changed to 0.757

    Held through RVU21B, RVU21C, RVU21D.

  8. January 1, 2020

    RVU20A

    $92.44changed to$90.12

    • Conversion factor 36.0391 changed to 36.0896
    • Practice expense RVU 1.43 changed to 1.37
    • Work GPCI 1.046 changed to 1.047
    • Practice expense GPCI 1.177 changed to 1.176
    • Malpractice GPCI 0.694 changed to 0.725

    Held through RVU20B, RVU20C, RVU20D.

  9. January 1, 2019

    RVU19A

    $94.88changed to$92.44

    • Conversion factor 35.9996 changed to 36.0391
    • Practice expense RVU 1.49 changed to 1.43

    Held through RVU19B, RVU19C, RVU19D.

  10. January 1, 2018

    RVU18AR1

    $95.87changed to$94.88

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 1.52 changed to 1.49
    • Work GPCI 1.047 changed to 1.046
    • Practice expense GPCI 1.169 changed to 1.177
    • Malpractice GPCI 0.801 changed to 0.694

    Held through RVU18B, RVU18C, RVU18D.

  11. January 1, 2017

    RVU17A

    $96.87changed to$95.87

    • Conversion factor 35.8043 changed to 35.8887
    • Practice expense RVU 1.55 changed to 1.52
    • Practice expense GPCI 1.161 changed to 1.169
    • Malpractice GPCI 0.908 changed to 0.801

    Held through RVU17B, RVU17C, RVU17D.

  12. January 1, 2016

    RVU16A

    $96.81changed to$96.87

    • Conversion factor 35.9335 changed to 35.8043
    • Practice expense RVU 1.54 changed to 1.55

    Held through RVU16B, RVU16C, RVU16D.

  13. July 1, 2015

    RVU15C

    $96.32changed to$96.81

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  14. January 1, 2015

    RVU15A

    $96.65changed to$96.32

    • Conversion factor 35.8228 changed to 35.7547
    • Practice expense RVU 1.57 changed to 1.54
    • Malpractice RVU 0.10 changed to 0.11
    • Work GPCI 1.042 changed to 1.047
    • Practice expense GPCI 1.158 changed to 1.161
    • Malpractice GPCI 0.775 changed to 0.908

    Held through RVU15B.

  15. January 1, 2014

    RVU14A

    $96.86changed to$96.65

    • Conversion factor 34.0230 changed to 35.8228
    • Practice expense RVU 1.72 changed to 1.57
    • Work GPCI 1.036 changed to 1.042
    • Practice expense GPCI 1.154 changed to 1.158
    • Malpractice GPCI 0.642 changed to 0.775

    Held through RVU14B, RVU14C, RVU14D.

  16. October 1, 2013

    RVU13D

    No ratechanged to$96.86

  17. January 1, 2013

    RVU13AR

    Earliest loaded release: No rate

    Held through RVU13B, RVU13C.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$85.42$57.76RVU26D
2026-07-01$85.42$57.76RVU26C
2026-04-01$85.42$57.76RVU26B
2026-01-01$85.42$57.76RVU26A
2025-10-01$81.16$64.16RVU25D
2025-07-01$81.16$64.16RVU25C
2025-04-01$81.16$64.16RVU25B
2025-01-01$81.16$64.16RVU25A
2024-10-01$83.69$65.01RVU24D
2024-07-01$83.69$65.01RVU24C
2024-04-01$83.69$65.01RVU24B
2024-03-09$83.69$65.01RVU24AR
2024-01-01$82.32$63.94RVU24A
2023-10-01$84.98$65.30RVU23D
2023-07-01$84.98$65.30RVU23C
2023-04-01$84.98$65.30RVU23B
2023-01-01$84.98$65.30RVU23A
2022-10-01$85.70$64.56RVU22D
2022-07-01$85.70$64.56RVU22C
2022-04-01$85.70$64.56RVU22B
2022-01-01$85.70$64.56RVU22A
2021-10-01$88.46$63.86RVU21D
2021-07-01$88.46$63.86RVU21C
2021-04-01$88.46$63.86RVU21B
2021-01-01$88.46$63.86RVU21A
2020-10-01$90.12$64.65RVU20D
2020-07-01$90.12$64.65RVU20C
2020-04-01$90.12$64.65RVU20B
2020-01-01$90.12$64.65RVU20A
2019-10-01$92.44$64.86RVU19D
2019-07-01$92.44$64.86RVU19C
2019-04-01$92.44$64.86RVU19B
2019-01-01$92.44$64.86RVU19A
2018-10-01$94.88$64.79RVU18D
2018-07-01$94.88$64.79RVU18C
2018-04-01$94.88$64.79RVU18B
2018-01-01$94.88$64.79RVU18AR1
2017-10-01$95.87$66.50RVU17D
2017-07-01$95.87$66.50RVU17C
2017-04-01$95.87$66.50RVU17B
2017-01-01$95.87$66.50RVU17A
2016-10-01$96.87$66.94RVU16D
2016-07-01$96.87$66.94RVU16C
2016-04-01$96.87$66.94RVU16B
2016-01-01$96.87$66.94RVU16A
2015-10-01$96.81$67.18RVU15D
2015-07-01$96.81$67.18RVU15C
2015-04-01$96.32$66.85RVU15B
2015-01-01$96.32$66.85RVU15A
2014-10-01$96.65$66.78RVU14D
2014-07-01$96.65$66.78RVU14C
2014-04-01$96.65$66.78RVU14B
2014-01-01$96.65$66.78RVU14A
2013-10-01$96.86$65.84RVU13D
2013-07-01Rate data unavailableRate data unavailableRVU13C
2013-04-01Rate data unavailableRate data unavailableRVU13B
2013-01-01Rate data unavailableRate data unavailableRVU13AR

Price 42650 for an earlier date of service

Where the Los Angeles, CA rate applies

Los Angeles, CA is a Medicare payment area, not a city. Our Census mapping connects it to 189 cities and communities in California. Some span more than one payment area; confirm with the service ZIP.

  • Anaheim
  • Long Beach
  • Los Angeles
  • Orange
  • Acton
  • Agoura Hills
  • Agua Dulce
  • Alhambra

Browse all communities in California

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
RVUs for 42650PPRRVU2026_Oct_nonQPP.csv, line 5,054 (RVU26D)
Geographic factors for Los Angeles, CAGPCI2026.csv, line 13 (RVU26D)

Open CMS sourceHow we calculate rates

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