CPT code 42650: Salivary duct dilation, percutaneous approach2026 Medicare rate & RVUs in Vermont
Percutaneous salivary duct dilation widens a narrowed duct through a skin approach, typically to address impaired salivary drainage from duct stenosis.
In Vermont, Medicare pays $74.53 for 42650 in the office and $51.38 when it’s performed in a hospital or facility.
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.
On this page 11 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.
How Vermont 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. Vermont pays $74.53. The RVUs are the same everywhere; the geographic indexes change the dollars.
- Vermont · this page$74.53
- Los Angeles, CA · California$85.42+$10.89
- Washington, DC area · District of Columbia$87.15+$12.62
- Miami, FL · Florida$84.41+$9.88
- Chicago, IL · Illinois$82.00+$7.47
- Manhattan, NY · New York$88.37+$13.84
- Alaska · Alaska$90.82+$16.29
Other areas in Vermont first, then benchmark localities. Bars start at $0.
Every other payment area
| Payment locality | Office | Facility |
|---|---|---|
| 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 |
| Madera, CACalifornia | $80.16 | $54.54 |
| 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 |
| Salinas, CACalifornia | $83.54 | $56.44 |
| San Diego, CACalifornia | $85.32 | $57.35 |
| Marin County, CACalifornia | $96.93 | $63.97 |
| San Francisco, CACalifornia | $96.81 | $63.84 |
| San Benito County, CACalifornia | $99.13 | $65.42 |
| Santa Clara County, CACalifornia | $98.62 | $64.91 |
| San Luis Obispo, CACalifornia | $82.23 | $55.60 |
| Santa Cruz, CACalifornia | $85.98 | $57.58 |
| Santa Maria, CACalifornia | $83.80 | $56.54 |
| Santa Rosa, CACalifornia | $86.83 | $58.12 |
| Stockton, CACalifornia | $80.16 | $54.54 |
| Vallejo, CACalifornia | $91.71 | $60.89 |
| Visalia, CACalifornia | $80.16 | $54.54 |
| Yuba City, CACalifornia | $80.16 | $54.54 |
| ColoradoColorado | $79.40 | $54.52 |
| ConnecticutConnecticut | $81.80 | $56.62 |
| DelawareDelaware | $76.00 | $52.90 |
| Fort Lauderdale, FLFlorida | $80.42 | $56.73 |
| Rest of FloridaFlorida | $76.55 | $54.20 |
| Atlanta, GAGeorgia | $78.41 | $54.65 |
| Rest of GeorgiaGeorgia | $72.33 | $51.48 |
| Hawaii, Guam, HIHawaii | $81.86 | $55.28 |
| IowaIowa | $70.52 | $49.13 |
| IdahoIdaho | $71.04 | $49.53 |
| East St. Louis, ILIllinois | $76.70 | $55.19 |
| Rest of IllinoisIllinois | $74.71 | $53.36 |
| Suburban Chicago, ILIllinois | $81.13 | $57.12 |
| IndianaIndiana | $71.42 | $49.75 |
| KansasKansas | $70.38 | $49.25 |
| KentuckyKentucky | $71.17 | $50.39 |
| New Orleans, LALouisiana | $74.48 | $52.48 |
| Rest of LouisianaLouisiana | $71.14 | $50.44 |
| Metropolitan Boston, MAMassachusetts | $86.78 | $58.86 |
| Rest of MassachusettsMassachusetts | $79.03 | $54.41 |
| Baltimore area, MDMaryland | $81.60 | $56.52 |
| Rest of MarylandMaryland | $77.35 | $53.69 |
| Rest of MaineMaine | $71.59 | $50.08 |
| Southern Maine, MEMaine | $75.03 | $51.86 |
| Detroit, MIMichigan | $77.66 | $55.10 |
| Rest of MichiganMichigan | $73.11 | $51.77 |
| MinnesotaMinnesota | $75.63 | $51.57 |
| Metropolitan Kansas City, MOMissouri | $73.80 | $51.85 |
| Metropolitan St. Louis, MOMissouri | $74.52 | $52.26 |
| Rest of MissouriMissouri | $70.09 | $49.94 |
| MississippiMississippi | $69.18 | $49.05 |
| MontanaMontana | $76.81 | $53.43 |
| North CarolinaNorth Carolina | $72.27 | $50.46 |
| North DakotaNorth Dakota | $74.64 | $51.26 |
| NebraskaNebraska | $70.83 | $49.25 |
| New HampshireNew Hampshire | $78.33 | $54.00 |
| Northern New JerseyNew Jersey | $86.35 | $59.22 |
| Rest of New JerseyNew Jersey | $82.61 | $57.07 |
| New MexicoNew Mexico | $73.57 | $52.13 |
| NevadaNevada | $76.26 | $52.85 |
| NYC suburbs and Long Island, NYNew York | $90.66 | $62.86 |
| Poughkeepsie and northern NYC suburbs, NYNew York | $83.29 | $57.69 |
| Queens, NYNew York | $88.80 | $61.17 |
| Rest of New YorkNew York | $73.33 | $51.11 |
| OhioOhio | $72.67 | $51.32 |
| OklahomaOklahoma | $70.86 | $49.98 |
| Portland, OROregon | $81.62 | $55.65 |
| Rest of OregonOregon | $75.54 | $52.25 |
| Metropolitan Philadelphia, PAPennsylvania | $79.95 | $55.61 |
| Rest of PennsylvaniaPennsylvania | $72.68 | $51.21 |
| Puerto RicoPuerto Rico | $77.30 | $53.66 |
| Rhode IslandRhode Island | $78.49 | $54.34 |
| South CarolinaSouth Carolina | $72.62 | $51.01 |
| South DakotaSouth Dakota | $74.38 | $51.00 |
| TennesseeTennessee | $70.74 | $49.49 |
| Austin, TXTexas | $79.24 | $54.51 |
| Beaumont, TXTexas | $72.23 | $50.96 |
| Brazoria, TXTexas | $75.78 | $52.61 |
| Dallas, TXTexas | $76.33 | $53.05 |
| Fort Worth, TXTexas | $75.90 | $52.85 |
| Galveston, TXTexas | $76.05 | $52.84 |
| Houston, TXTexas | $78.07 | $54.85 |
| Rest of TexasTexas | $74.01 | $51.82 |
| UtahUtah | $73.56 | $51.58 |
| VirginiaVirginia | $74.92 | $51.94 |
| Virgin Islands, VIUnited States Virgin Islands | $77.30 | $53.66 |
| Rest of WashingtonWashington | $78.82 | $54.20 |
| King County, WAWashington | $88.32 | $59.63 |
| WisconsinWisconsin | $72.26 | $49.86 |
| West VirginiaWest Virginia | $72.10 | $51.79 |
| WyomingWyoming | $75.87 | $52.49 |
42650 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.
$68.26
$90.82
Color shows the midpoint of each state’s locality range.
View every state and territory as a table
| State / territory | Office rate range | Localities |
|---|---|---|
| AK | $90.82 | 1 |
| AL | $69.22 | 1 |
| AR | $68.26 | 1 |
| AZ | $74.80 | 1 |
| CA | $80.16–$99.13 | 29 |
| CO | $79.40 | 1 |
| CT | $81.80 | 1 |
| DC | $87.15 | 1 |
| DE | $76.00 | 1 |
| FL | $76.55–$84.41 | 3 |
| GA | $72.33–$78.41 | 2 |
| GU | $81.86 | 1 |
| HI | $81.86 | 1 |
| IA | $70.52 | 1 |
| ID | $71.04 | 1 |
| IL | $74.71–$82.00 | 4 |
| IN | $71.42 | 1 |
| KS | $70.38 | 1 |
| KY | $71.17 | 1 |
| LA | $71.14–$74.48 | 2 |
| MA | $79.03–$86.78 | 2 |
| MD | $77.35–$87.15 | 3 |
| ME | $71.59–$75.03 | 2 |
| MI | $73.11–$77.66 | 2 |
| MN | $75.63 | 1 |
| MO | $70.09–$74.52 | 3 |
| MS | $69.18 | 1 |
| MT | $76.81 | 1 |
| NC | $72.27 | 1 |
| ND | $74.64 | 1 |
| NE | $70.83 | 1 |
| NH | $78.33 | 1 |
| NJ | $82.61–$86.35 | 2 |
| NM | $73.57 | 1 |
| NV | $76.26 | 1 |
| NY | $73.33–$90.66 | 5 |
| OH | $72.67 | 1 |
| OK | $70.86 | 1 |
| OR | $75.54–$81.62 | 2 |
| PA | $72.68–$79.95 | 2 |
| PR | $77.30 | 1 |
| RI | $78.49 | 1 |
| SC | $72.62 | 1 |
| SD | $74.38 | 1 |
| TN | $70.74 | 1 |
| TX | $72.23–$79.24 | 8 |
| UT | $73.56 | 1 |
| VA | $74.92–$87.15 | 2 |
| VI | $77.30 | 1 |
| VT | $74.53 | 1 |
| WA | $78.82–$88.32 | 2 |
| WI | $72.26 | 1 |
| WV | $72.10 | 1 |
| WY | $75.87 | 1 |
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.
The exact Vermont 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
105
- Locality
- Vermont
- Physician work
- 1.000
- Practice expense
- 0.990
- Malpractice
- 0.506
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 0.75 | × 1.000 | 0.7500 |
| Practice expense | 1.44 | × 0.990 | 1.4256 |
| Malpractice | 0.11 | × 0.506 | 0.0557 |
| Total RVUs | 2.2313 | ||
| Conversion factor | × 33.4009 | ||
Office rate, Vermont$74.53
Office: (0.75 × 1 + 1.44 × 0.99 + 0.11 × 0.506) × $33.4009 = $74.53
Facility: (0.75 × 1 + 0.74 × 0.99 + 0.11 × 0.506) × $33.4009 = $51.38
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%).
How 42650 has changed in Vermont
42650 · Office / nonfacility
$74.53
Effective 2026-10-01
The base rate is $3.93 higher than on 2025-10-01, moving from $70.60 to $74.53 (5.6%).
It is unchanged from the immediately preceding available release, effective 2026-07-01.
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
January 1, 2026
RVU26A
$70.60changed to$74.53
- 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 0.993 changed to 0.990
- Malpractice GPCI 0.518 changed to 0.506
Held through RVU26B, RVU26C, RVU26D.
January 1, 2025
RVU25A
$72.81changed to$70.60
- 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.
March 9, 2024
RVU24AR
$71.62changed to$72.81
- Conversion factor 32.7442 changed to 33.2875
Held through RVU24B, RVU24C, RVU24D.
January 1, 2024
RVU24A
$74.40changed to$71.62
- Conversion factor 33.8872 changed to 32.7442
- Practice expense GPCI 0.997 changed to 0.993
- Malpractice GPCI 0.543 changed to 0.518
January 1, 2023
RVU23A
$75.58changed to$74.40
- Conversion factor 34.6062 changed to 33.8872
- Practice expense RVU 1.35 changed to 1.37
- Practice expense GPCI 1.001 changed to 0.997
- Malpractice GPCI 0.569 changed to 0.543
Held through RVU23B, RVU23C, RVU23D.
January 1, 2022
RVU22A
$77.95changed to$75.58
- Conversion factor 34.8931 changed to 34.6062
- Practice expense RVU 1.40 changed to 1.35
Held through RVU22B, RVU22C, RVU22D.
January 1, 2021
RVU21A
$79.94changed to$77.95
- Conversion factor 36.0896 changed to 34.8931
- Practice expense RVU 1.37 changed to 1.40
- Practice expense GPCI 1.008 changed to 1.001
- Malpractice GPCI 0.582 changed to 0.569
Held through RVU21B, RVU21C, RVU21D.
January 1, 2020
RVU20A
$82.42changed to$79.94
- Conversion factor 36.0391 changed to 36.0896
- Practice expense RVU 1.43 changed to 1.37
- Practice expense GPCI 1.015 changed to 1.008
- Malpractice GPCI 0.595 changed to 0.582
Held through RVU20B, RVU20C, RVU20D.
January 1, 2019
RVU19A
$84.52changed to$82.42
- Conversion factor 35.9996 changed to 36.0391
- Practice expense RVU 1.49 changed to 1.43
Held through RVU19B, RVU19C, RVU19D.
January 1, 2018
RVU18AR1
$85.25changed to$84.52
- Conversion factor 35.8887 changed to 35.9996
- Practice expense RVU 1.52 changed to 1.49
- Practice expense GPCI 1.010 changed to 1.015
- Malpractice GPCI 0.639 changed to 0.595
Held through RVU18B, RVU18C, RVU18D.
January 1, 2017
RVU17A
$85.97changed to$85.25
- Conversion factor 35.8043 changed to 35.8887
- Practice expense RVU 1.55 changed to 1.52
- Practice expense GPCI 1.004 changed to 1.010
- Malpractice GPCI 0.682 changed to 0.639
Held through RVU17B, RVU17C, RVU17D.
January 1, 2016
RVU16A
$85.92changed to$85.97
- Conversion factor 35.9335 changed to 35.8043
- Practice expense RVU 1.54 changed to 1.55
Held through RVU16B, RVU16C, RVU16D.
July 1, 2015
RVU15C
$85.50changed to$85.92
- Conversion factor 35.7547 changed to 35.9335
Held through RVU15D.
January 1, 2015
RVU15A
$86.38changed to$85.50
- 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 1.006 changed to 1.004
- Malpractice GPCI 0.618 changed to 0.682
Held through RVU15B.
January 1, 2014
RVU14A
No ratechanged to$86.38
Held through RVU14B, RVU14C, RVU14D.
January 1, 2013
RVU13AR
Earliest loaded release: No rate
Held through RVU13B, RVU13C, RVU13D.
| Effective from | Office | Facility | CMS release |
|---|---|---|---|
| 2026-10-01 | $74.53 | $51.38 | RVU26D |
| 2026-07-01 | $74.53 | $51.38 | RVU26C |
| 2026-04-01 | $74.53 | $51.38 | RVU26B |
| 2026-01-01 | $74.53 | $51.38 | RVU26A |
| 2025-10-01 | $70.60 | $56.47 | RVU25D |
| 2025-07-01 | $70.60 | $56.47 | RVU25C |
| 2025-04-01 | $70.60 | $56.47 | RVU25B |
| 2025-01-01 | $70.60 | $56.47 | RVU25A |
| 2024-10-01 | $72.81 | $57.28 | RVU24D |
| 2024-07-01 | $72.81 | $57.28 | RVU24C |
| 2024-04-01 | $72.81 | $57.28 | RVU24B |
| 2024-03-09 | $72.81 | $57.28 | RVU24AR |
| 2024-01-01 | $71.62 | $56.34 | RVU24A |
| 2023-10-01 | $74.40 | $57.85 | RVU23D |
| 2023-07-01 | $74.40 | $57.85 | RVU23C |
| 2023-04-01 | $74.40 | $57.85 | RVU23B |
| 2023-01-01 | $74.40 | $57.85 | RVU23A |
| 2022-10-01 | $75.58 | $57.56 | RVU22D |
| 2022-07-01 | $75.58 | $57.56 | RVU22C |
| 2022-04-01 | $75.58 | $57.56 | RVU22B |
| 2022-01-01 | $75.58 | $57.56 | RVU22A |
| 2021-10-01 | $77.95 | $56.99 | RVU21D |
| 2021-07-01 | $77.95 | $56.99 | RVU21C |
| 2021-04-01 | $77.95 | $56.99 | RVU21B |
| 2021-01-01 | $77.95 | $56.99 | RVU21A |
| 2020-10-01 | $79.94 | $58.11 | RVU20D |
| 2020-07-01 | $79.94 | $58.11 | RVU20C |
| 2020-04-01 | $79.94 | $58.11 | RVU20B |
| 2020-01-01 | $79.94 | $58.11 | RVU20A |
| 2019-10-01 | $82.42 | $58.64 | RVU19D |
| 2019-07-01 | $82.42 | $58.64 | RVU19C |
| 2019-04-01 | $82.42 | $58.64 | RVU19B |
| 2019-01-01 | $82.42 | $58.64 | RVU19A |
| 2018-10-01 | $84.52 | $58.58 | RVU18D |
| 2018-07-01 | $84.52 | $58.58 | RVU18C |
| 2018-04-01 | $84.52 | $58.58 | RVU18B |
| 2018-01-01 | $84.52 | $58.58 | RVU18AR1 |
| 2017-10-01 | $85.25 | $59.88 | RVU17D |
| 2017-07-01 | $85.25 | $59.88 | RVU17C |
| 2017-04-01 | $85.25 | $59.88 | RVU17B |
| 2017-01-01 | $85.25 | $59.88 | RVU17A |
| 2016-10-01 | $85.97 | $60.09 | RVU16D |
| 2016-07-01 | $85.97 | $60.09 | RVU16C |
| 2016-04-01 | $85.97 | $60.09 | RVU16B |
| 2016-01-01 | $85.97 | $60.09 | RVU16A |
| 2015-10-01 | $85.92 | $60.31 | RVU15D |
| 2015-07-01 | $85.92 | $60.31 | RVU15C |
| 2015-04-01 | $85.50 | $60.01 | RVU15B |
| 2015-01-01 | $85.50 | $60.01 | RVU15A |
| 2014-10-01 | $86.38 | $60.43 | RVU14D |
| 2014-07-01 | $86.38 | $60.43 | RVU14C |
| 2014-04-01 | $86.38 | $60.43 | RVU14B |
| 2014-01-01 | $86.38 | $60.43 | RVU14A |
| 2013-10-01 | Rate data unavailable | Rate data unavailable | RVU13D |
| 2013-07-01 | Rate data unavailable | Rate data unavailable | RVU13C |
| 2013-04-01 | Rate data unavailable | Rate data unavailable | RVU13B |
| 2013-01-01 | Rate data unavailable | Rate data unavailable | RVU13AR |
Where the Vermont rate applies
Vermont is a Medicare payment area, not a city. Our Census mapping connects it to 180 cities and communities in Vermont. Some span more than one payment area; confirm with the service ZIP.
- Albany
- Alburgh
- Algiers
- Arlington
- Ascutney
- Bakersfield
- Barnet
- Barre
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
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