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CPT code 42650: Salivary duct dilation, percutaneous approach2026 Medicare rate & RVUs in Puerto Rico

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 Puerto Rico, Medicare pays $77.30 for 42650 in the office and $53.66 when it’s performed in a hospital or facility.

$77.30Office (non-facility)
$53.66Hospital or facility
+0.6%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 Puerto Rico
  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 Puerto Rico 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. Puerto Rico pays $77.30. The RVUs are the same everywhere; the geographic indexes change the dollars.

42650 in Puerto Rico vs other payment areas
  1. Puerto Rico · this page$77.30
  2. Los Angeles, CA · California$85.42+$8.12
  3. Washington, DC area · District of Columbia$87.15+$9.85
  4. Miami, FL · Florida$84.41+$7.11
  5. Chicago, IL · Illinois$82.00+$4.70
  6. Manhattan, NY · New York$88.37+$11.07
  7. Alaska · Alaska$90.82+$13.52

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

Every other payment area

42650 in every other Medicare payment locality
Payment localityOfficeFacility
AlabamaAlabama$69.22$48.76
ArkansasArkansas$68.26$48.17
ArizonaArizona$74.80$52.15
Bakersfield, CACalifornia$80.48$54.85
Chico, CACalifornia$80.16$54.54
El Centro, CACalifornia$80.18$54.55
Fresno, CACalifornia$80.16$54.54
Hanford, CACalifornia$80.16$54.54

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 Puerto Rico 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

91

Locality
Puerto Rico
Physician work
1.000
Practice expense
1.011
Malpractice
0.985
Office calculation for 42650 in Puerto Rico
ComponentRVULocality factorAdjusted
Physician work0.75× 1.0000.7500
Practice expense1.44× 1.0111.4558
Malpractice0.11× 0.9850.1084
Total RVUs2.3142
Conversion factor× 33.4009

Office rate, Puerto Rico$77.30

Office: (0.75 × 1 + 1.44 × 1.011 + 0.11 × 0.985) × $33.4009 = $77.30

Facility: (0.75 × 1 + 0.74 × 1.011 + 0.11 × 0.985) × $33.4009 = $53.66

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, Puerto Rico
Same family
42660Salivary duct dilation, complicated procedureSalivary duct dilation through an intraoral rather than percutaneous approach.$102.79
42600Fistula closure, salivary tractRelated salivary duct surgery code for closure of a fistula, not duct dilation.$542.98
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 Puerto Rico

42650 · Office / nonfacility

$77.30

Effective 2026-10-01

The base rate is $4.28 higher than on 2025-10-01, moving from $73.02 to $77.30 (5.9%).

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

    $73.02changed to$77.30

    • 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
    • Practice expense GPCI 1.007 changed to 1.011
    • Malpractice GPCI 0.982 changed to 0.985

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $75.15changed to$73.02

    • 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

    $73.92changed to$75.15

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $76.56changed to$73.92

    • Conversion factor 33.8872 changed to 32.7442
    • Practice expense GPCI 1.008 changed to 1.007
    • Malpractice GPCI 0.984 changed to 0.982

  5. October 1, 2023

    RVU23D

    $76.25changed to$76.56

    • Practice expense GPCI 1.000 changed to 1.008
    • Malpractice GPCI 1.000 changed to 0.984

  6. January 1, 2023

    RVU23A

    $77.49changed to$76.25

    • Conversion factor 34.6062 changed to 33.8872
    • Practice expense RVU 1.35 changed to 1.37
    • Practice expense GPCI 1.008 changed to 1.000
    • Malpractice GPCI 0.986 changed to 1.000

    Held through RVU23B, RVU23C.

  7. January 1, 2022

    RVU22A

    $79.89changed to$77.49

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

    Held through RVU22B, RVU22C, RVU22D.

  8. January 1, 2021

    RVU21A

    $81.55changed to$79.89

    • Conversion factor 36.0896 changed to 34.8931
    • Practice expense RVU 1.37 changed to 1.40
    • Malpractice GPCI 0.988 changed to 0.986

    Held through RVU21B, RVU21C, RVU21D.

  9. January 1, 2020

    RVU20A

    $83.57changed to$81.55

    • Conversion factor 36.0391 changed to 36.0896
    • Practice expense RVU 1.43 changed to 1.37
    • Practice expense GPCI 1.007 changed to 1.008
    • Malpractice GPCI 0.990 changed to 0.988

    Held through RVU20B, RVU20C, RVU20D.

  10. January 1, 2019

    RVU19A

    $85.65changed to$83.57

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

    Held through RVU19B, RVU19C, RVU19D.

  11. January 1, 2018

    RVU18AR1

    $76.86changed to$85.65

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 1.52 changed to 1.49
    • Practice expense GPCI 0.856 changed to 1.007
    • Malpractice GPCI 0.642 changed to 0.990

    Held through RVU18B, RVU18C, RVU18D.

  12. January 1, 2017

    RVU17A

    $67.85changed to$76.86

    • Conversion factor 35.8043 changed to 35.8887
    • Practice expense RVU 1.55 changed to 1.52
    • Practice expense GPCI 0.705 changed to 0.856
    • Malpractice GPCI 0.293 changed to 0.642

    Held through RVU17B, RVU17C, RVU17D.

  13. January 1, 2016

    RVU16A

    $67.84changed to$67.85

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

    Held through RVU16B, RVU16C, RVU16D.

  14. July 1, 2015

    RVU15C

    $67.50changed to$67.84

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  15. January 1, 2015

    RVU15A

    $67.47changed to$67.50

    • 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
    • Practice expense GPCI 0.692 changed to 0.705
    • Malpractice GPCI 0.271 changed to 0.293

    Held through RVU15B.

  16. January 1, 2014

    RVU14A

    $66.72changed to$67.47

    • Conversion factor 34.0230 changed to 35.8228
    • Practice expense RVU 1.72 changed to 1.57
    • Practice expense GPCI 0.678 changed to 0.692
    • Malpractice GPCI 0.249 changed to 0.271

    Held through RVU14B, RVU14C, RVU14D.

  17. January 1, 2013

    RVU13AR

    Earliest loaded release: $66.72

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$77.30$53.66RVU26D
2026-07-01$77.30$53.66RVU26C
2026-04-01$77.30$53.66RVU26B
2026-01-01$77.30$53.66RVU26A
2025-10-01$73.02$58.69RVU25D
2025-07-01$73.02$58.69RVU25C
2025-04-01$73.02$58.69RVU25B
2025-01-01$73.02$58.69RVU25A
2024-10-01$75.15$59.40RVU24D
2024-07-01$75.15$59.40RVU24C
2024-04-01$75.15$59.40RVU24B
2024-03-09$75.15$59.40RVU24AR
2024-01-01$73.92$58.43RVU24A
2023-10-01$76.56$59.82RVU23D
2023-07-01$76.25$59.64RVU23C
2023-04-01$76.25$59.64RVU23B
2023-01-01$76.25$59.64RVU23A
2022-10-01$77.49$59.35RVU22D
2022-07-01$77.49$59.35RVU22C
2022-04-01$77.49$59.35RVU22B
2022-01-01$77.49$59.35RVU22A
2021-10-01$79.89$58.79RVU21D
2021-07-01$79.89$58.79RVU21C
2021-04-01$79.89$58.79RVU21B
2021-01-01$79.89$58.79RVU21A
2020-10-01$81.55$59.72RVU20D
2020-07-01$81.55$59.72RVU20C
2020-04-01$81.55$59.72RVU20B
2020-01-01$81.55$59.72RVU20A
2019-10-01$83.57$59.98RVU19D
2019-07-01$83.57$59.98RVU19C
2019-04-01$83.57$59.98RVU19B
2019-01-01$83.57$59.98RVU19A
2018-10-01$85.65$59.92RVU18D
2018-07-01$85.65$59.92RVU18C
2018-04-01$85.65$59.92RVU18B
2018-01-01$85.65$59.92RVU18AR1
2017-10-01$76.86$55.36RVU17D
2017-07-01$76.86$55.36RVU17C
2017-04-01$76.86$55.36RVU17B
2017-01-01$76.86$55.36RVU17A
2016-10-01$67.85$49.67RVU16D
2016-07-01$67.85$49.67RVU16C
2016-04-01$67.85$49.67RVU16B
2016-01-01$67.85$49.67RVU16A
2015-10-01$67.84$49.85RVU15D
2015-07-01$67.84$49.85RVU15C
2015-04-01$67.50$49.61RVU15B
2015-01-01$67.50$49.61RVU15A
2014-10-01$67.47$49.63RVU14D
2014-07-01$67.47$49.63RVU14C
2014-04-01$67.47$49.63RVU14B
2014-01-01$67.47$49.63RVU14A
2013-10-01$66.72$48.50RVU13D
2013-07-01$66.72$48.50RVU13C
2013-04-01$66.72$48.50RVU13B
2013-01-01$66.72$48.50RVU13AR

Price 42650 for an earlier date of service

Where the Puerto Rico rate applies

Puerto Rico is a Medicare payment area, not a city. Our Census mapping connects it to 292 cities and communities in Puerto Rico. Some span more than one payment area; confirm with the service ZIP.

  • Aceitunas
  • Adjuntas
  • Aguada
  • Aguadilla
  • Aguas Buenas
  • Aguas Claras
  • Aguilita
  • Aibonito

Browse all communities in Puerto Rico

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 Puerto RicoGPCI2026.csv, line 91 (RVU26D)

Open CMS sourceHow we calculate rates

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