CPT code 42665: Salivary duct surgery, duct interruption2026 Medicare rate & RVUs in Marin County, CA

Reports operative ligation of a salivary duct, such as when a surgeon intentionally interrupts salivary flow for a selected clinical indication.

CMS RVU26DEffective Oct 1, 2026One payment locality

In Marin County, CA, Medicare pays $480.46 for 42665 in the office and $239.33 when it’s performed in a hospital or facility.

$480.46Office (non-facility)
$239.33Hospital or facility
+30.4%vs the national office rate ($368.41)

Check a contract rate as a % of Medicare · 42665 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 42665 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in Marin County, CA
  2. What 42665 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 42665 covers

The surgeon exposes and ties off a salivary duct to interrupt flow from the associated gland. This may be considered for selected patients with troublesome drooling or persistent salivary leakage. Otolaryngologists, oral and maxillofacial surgeons, and head and neck surgeons typically perform the operation in a surgical setting. The operative note should identify the duct and gland treated, the reason for ligation, and the technique used.

Report 42665 when the procedure actually ligates the duct; dilation of a narrowed duct and direct closure of a salivary fistula are different services. 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 50% multiple-procedure reduction. The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care. Assistant-at-surgery payment requires documentation of 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 Marin County, CA compares for 42665

Across 109 of 109 payment localities, the office rate for 42665 runs from $324.16 in Arkansas to $491.36 in San Benito County, CA. Marin County, CA pays $480.46. The RVUs are the same everywhere; the geographic indexes change the dollars.

42665 in Marin County, CA vs other payment areas
  1. Marin County, CA · this page$480.46
  2. Bakersfield, CA · California$391.01−$89.45
  3. Chico, CA · California$389.92−$90.54
  4. El Centro, CA · California$389.98−$90.48
  5. Fresno, CA · California$389.92−$90.54
  6. Hanford, CA · California$389.92−$90.54
  7. Los Angeles, CA · California$417.10−$63.36

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

Every other payment area

42665 in every other Medicare payment locality
Payment localityOfficeFacility
Madera, CACalifornia$389.92$202.49
Merced, CACalifornia$389.92$202.49
Modesto, CACalifornia$389.92$202.49
Napa, CACalifornia$453.48$228.09
Oxnard, CACalifornia$415.20$213.06
Redding, CACalifornia$389.92$202.49
Rest of CaliforniaCalifornia$389.92$202.49
Riverside, CACalifornia$394.03$206.60

42665 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.

$324.16

$440.64

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

View every state and territory as a table
42665 office rate range by state
State / territoryOffice rate rangeLocalities
AK$423.031
AL$329.131
AR$324.161
AZ$358.211
CA$389.92–$491.3629
CO$383.951
CT$393.591
DC$422.561
DE$364.311
FL$362.91–$398.903
GA$341.67–$375.542
GU$400.091
HI$400.091
IA$337.791
ID$340.111
IL$352.05–$386.804
IN$342.161
KS$336.181
KY$337.341
LA$336.80–$354.202
MA$381.52–$422.942
MD$371.47–$422.563
ME$342.00–$361.302
MI$346.54–$367.662
MN$367.311
MO$330.79–$355.473
MS$327.541
MT$368.391
NC$345.731
ND$360.871
NE$339.711
NH$377.901
NJ$397.92–$417.902
NM$348.541
NV$366.561
NY$351.13–$435.835
OH$345.001
OK$336.671
OR$363.56–$396.522
PA$345.56–$383.482
PR$371.191
RI$377.581
SC$345.971
SD$359.981
TN$337.951
TX$343.19–$382.818
UT$350.901
VA$360.09–$422.562
VI$371.191
VT$359.441
WA$380.81–$431.702
WI$348.281
WV$338.481
WY$365.111

See 42665 in every payment locality

How the 42665 rate is calculated

Each of 42665’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 · 42665

RVUs × geographic indexes × conversion factor

Office or facility?

Work2.56

2.56 RVUs× 1.000 GPCI

Practice expense8.09

8.09 RVUs× 1.000 GPCI

Malpractice0.38

0.38 RVUs× 1.000 GPCI

Adjusted RVUs

11.0300

Conversion factor

$33.4009

Medicare rate

$368.41

Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.

The exact Marin County, CA inputs and CMS source lines

PPRRVU2026_Oct_nonQPP.csv

5,057

Code
42665
Physician work
2.56
Practice expense
8.09
Malpractice
0.38

GPCI2026.csv

25

Locality
Marin County, CA
Physician work
1.095
Practice expense
1.410
Malpractice
0.459
Office calculation for 42665 in Marin County, CA
ComponentRVULocality factorAdjusted
Physician work2.56× 1.0952.8032
Practice expense8.09× 1.41011.4069
Malpractice0.38× 0.4590.1744
Total RVUs14.3845
Conversion factor× 33.4009

Office rate, Marin County, CA$480.46

Office: (2.56 × 1.095 + 8.09 × 1.41 + 0.38 × 0.459) × $33.4009 = $480.46

Facility: (2.56 × 1.095 + 2.97 × 1.41 + 0.38 × 0.459) × $33.4009 = $239.33

Open 42665 in the RVU calculator

Payment rules and modifiers for 42665

42665 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 42665

Salivary duct surgery, duct interruption

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 · 42665

Salivary duct surgery, duct interruption

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

42665 without 51 · national office

$368.41

Salivary duct surgery, duct interruption

42665-51 · Second procedure: 50%

$184.21

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

How 42665 has changed in Marin County, CA

42665 · Office / nonfacility

$480.46

Effective 2026-10-01

The base rate is $6.51 higher than on 2025-10-01, moving from $473.95 to $480.46 (1.4%).

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

    $473.95changed to$480.46

    • Conversion factor 32.3465 changed to 33.4009
    • Work RVU 2.63 changed to 2.56
    • Practice expense RVU 8.18 changed to 8.09
    • Malpractice RVU 0.39 changed to 0.38
    • Work GPCI 1.088 changed to 1.095
    • Practice expense GPCI 1.419 changed to 1.410
    • Malpractice GPCI 0.470 changed to 0.459

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $496.24changed to$473.95

    • Conversion factor 33.2875 changed to 32.3465
    • Practice expense RVU 8.36 changed to 8.18

    Held through RVU25B, RVU25C, RVU25D.

  3. March 9, 2024

    RVU24AR

    $488.14changed to$496.24

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $494.12changed to$488.14

    • Conversion factor 33.8872 changed to 32.7442
    • Practice expense RVU 8.41 changed to 8.36
    • Malpractice RVU 0.37 changed to 0.39
    • Work GPCI 1.082 changed to 1.088
    • Practice expense GPCI 1.374 changed to 1.419
    • Malpractice GPCI 0.487 changed to 0.470
  5. January 1, 2023

    RVU23A

    $487.59changed to$494.12

    • Conversion factor 34.6062 changed to 33.8872
    • Practice expense RVU 8.33 changed to 8.41
    • Work GPCI 1.077 changed to 1.082
    • Practice expense GPCI 1.329 changed to 1.374
    • Malpractice GPCI 0.504 changed to 0.487

    Held through RVU23B, RVU23C, RVU23D.

  6. January 1, 2022

    RVU22A

    $466.00changed to$487.59

    • Conversion factor 34.8931 changed to 34.6062
    • Practice expense RVU 7.90 changed to 8.33
    • Malpractice RVU 0.36 changed to 0.37
    • Work GPCI 1.071 changed to 1.077
    • Practice expense GPCI 1.311 changed to 1.329

    Held through RVU22B, RVU22C, RVU22D.

  7. January 1, 2021

    RVU21A

    $428.11changed to$466.00

    • Conversion factor 36.0896 changed to 34.8931
    • Practice expense RVU 6.84 changed to 7.90
    • Malpractice RVU 0.35 changed to 0.36
    • Work GPCI 1.068 changed to 1.071
    • Practice expense GPCI 1.299 changed to 1.311
    • Malpractice GPCI 0.481 changed to 0.504

    Held through RVU21B, RVU21C, RVU21D.

  8. January 1, 2020

    RVU20A

    $405.45changed to$428.11

    • Conversion factor 36.0391 changed to 36.0896
    • Practice expense RVU 6.41 changed to 6.84
    • Malpractice RVU 0.38 changed to 0.35
    • Work GPCI 1.065 changed to 1.068
    • Practice expense GPCI 1.291 changed to 1.299
    • Malpractice GPCI 0.458 changed to 0.481

    Held through RVU20B, RVU20C, RVU20D.

  9. January 1, 2019

    RVU19A

    $378.77changed to$405.45

    • Conversion factor 35.9996 changed to 36.0391
    • Practice expense RVU 5.91 changed to 6.41
    • Malpractice RVU 0.37 changed to 0.38
    • Work GPCI 1.062 changed to 1.065
    • Practice expense GPCI 1.279 changed to 1.291

    Held through RVU19B, RVU19C, RVU19D.

  10. January 1, 2018

    RVU18AR1

    $382.96changed to$378.77

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 6.06 changed to 5.91
    • Malpractice RVU 0.39 changed to 0.37
    • Work GPCI 1.058 changed to 1.062
    • Practice expense GPCI 1.271 changed to 1.279
    • Malpractice GPCI 0.477 changed to 0.458

    Held through RVU18B, RVU18C, RVU18D.

  11. January 1, 2017

    RVU17A

    No ratechanged to$382.96

    Held through RVU17B, RVU17C, RVU17D.

  12. January 1, 2013

    RVU13AR

    Earliest loaded release: No rate

    Held through RVU13B, RVU13C, RVU13D, RVU14A, RVU14B, RVU14C, RVU14D, RVU15A, RVU15B, RVU15C, RVU15D, RVU16A, RVU16B, RVU16C, RVU16D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$480.46$239.33RVU26D
2026-07-01$480.46$239.33RVU26C
2026-04-01$480.46$239.33RVU26B
2026-01-01$480.46$239.33RVU26A
2025-10-01$473.95$265.56RVU25D
2025-07-01$473.95$265.56RVU25C
2025-04-01$473.95$265.56RVU25B
2025-01-01$473.95$265.56RVU25A
2024-10-01$496.24$271.40RVU24D
2024-07-01$496.24$271.40RVU24C
2024-04-01$496.24$271.40RVU24B
2024-03-09$496.24$271.40RVU24AR
2024-01-01$488.14$266.97RVU24A
2023-10-01$494.12$266.43RVU23D
2023-07-01$494.12$266.43RVU23C
2023-04-01$494.12$266.43RVU23B
2023-01-01$494.12$266.43RVU23A
2022-10-01$487.59$259.01RVU22D
2022-07-01$487.59$259.01RVU22C
2022-04-01$487.59$259.01RVU22B
2022-01-01$487.59$259.01RVU22A
2021-10-01$466.00$250.08RVU21D
2021-07-01$466.00$250.08RVU21C
2021-04-01$466.00$250.08RVU21B
2021-01-01$466.00$250.08RVU21A
2020-10-01$428.11$247.62RVU20D
2020-07-01$428.11$247.62RVU20C
2020-04-01$428.11$247.62RVU20B
2020-01-01$428.11$247.62RVU20A
2019-10-01$405.45$244.47RVU19D
2019-07-01$405.45$244.47RVU19C
2019-04-01$405.45$244.47RVU19B
2019-01-01$405.45$244.47RVU19A
2018-10-01$378.77$239.25RVU18D
2018-07-01$378.77$239.25RVU18C
2018-04-01$378.77$239.25RVU18B
2018-01-01$378.77$239.25RVU18AR1
2017-10-01$382.96$242.93RVU17D
2017-07-01$382.96$242.93RVU17C
2017-04-01$382.96$242.93RVU17B
2017-01-01$382.96$242.93RVU17A
2016-10-01Rate data unavailableRate data unavailableRVU16D
2016-07-01Rate data unavailableRate data unavailableRVU16C
2016-04-01Rate data unavailableRate data unavailableRVU16B
2016-01-01Rate data unavailableRate data unavailableRVU16A
2015-10-01Rate data unavailableRate data unavailableRVU15D
2015-07-01Rate data unavailableRate data unavailableRVU15C
2015-04-01Rate data unavailableRate data unavailableRVU15B
2015-01-01Rate data unavailableRate data unavailableRVU15A
2014-10-01Rate data unavailableRate data unavailableRVU14D
2014-07-01Rate data unavailableRate data unavailableRVU14C
2014-04-01Rate data unavailableRate data unavailableRVU14B
2014-01-01Rate data unavailableRate data unavailableRVU14A
2013-10-01Rate data unavailableRate data unavailableRVU13D
2013-07-01Rate data unavailableRate data unavailableRVU13C
2013-04-01Rate data unavailableRate data unavailableRVU13B
2013-01-01Rate data unavailableRate data unavailableRVU13AR

Price 42665 for an earlier date of service

Where the Marin County, CA rate applies

Marin County, CA is a Medicare payment area, not a city. Our Census mapping connects it to 31 cities and communities in California. Some span more than one payment area; confirm with the service ZIP.

  • Alto
  • Belvedere
  • Black Point-Green Point
  • Bolinas
  • Corte Madera
  • Dillon Beach
  • Fairfax
  • Inverness

Browse all communities in California

42665 billing questions

How is duct ligation different from salivary duct dilation?

Ligation intentionally interrupts salivary flow. Dilation opens a narrowed duct to restore or improve flow.

Is ligation the same as closing a salivary fistula?

No. Ligation ties off a duct, while fistula closure directly repairs the abnormal communication. Report the procedure actually performed.

What documentation supports 42665?

The operative note should identify the duct and gland, the clinical reason for interruption, and the ligation performed.

How does the 90-day global period affect postoperative care?

The day-before preoperative visit and 90 days of related postoperative care are included in the global period.

Can an assistant surgeon be reported?

Assistant-at-surgery payment is allowed only when the record documents medical necessity. Co-surgeons and team surgery are not permitted for this code.

What happens when another procedure is performed in the same session?

The highest-valued procedure is paid in full, and other procedures are subject to the standard multiple-procedure reduction.

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 42665PPRRVU2026_Oct_nonQPP.csv, line 5,057 (RVU26D)
Geographic factors for Marin County, CAGPCI2026.csv, line 25 (RVU26D)

Open CMS sourceHow we calculate rates

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