CPT code 42665: Salivary duct surgery, duct interruption2026 Medicare rate & RVUs in Missouri
Reports operative ligation of a salivary duct, such as when a surgeon intentionally interrupts salivary flow for a selected clinical indication.
Medicare pays $330.79–$355.47 for 42665 in the office in Missouri, from Rest of Missouri to Metropolitan St. Louis, MO. 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 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.
Where 42665 pays more and less in Missouri
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
3 payment localities
$330.79 to $355.47
| Payment locality | Office | Facility |
|---|---|---|
| Metropolitan Kansas City, MO | $351.64 | $191.06 |
| Metropolitan St. Louis, MO | $355.47 | $192.66 |
| Rest of Missouri | $330.79 | $183.38 |
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
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.
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
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 090 | Major surgery: the day before, the day of, and 90 days after are 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) | 0 | Not paid without supporting documentation. |
| Co-surgeons (62) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
| Split (54/55/56) | 0.09/0.81/0.10 | Share 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.
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%).
42665 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 42600Fistula closureSalivary tract
- 42600 is for direct closure of a salivary fistula. Use 42665 when the surgeon ligates a duct to interrupt salivary flow.
- 42650Salivary duct dilationPercutaneous approach
- 42650 describes dilation of a salivary duct. It is not the code for tying off the duct.
- 42660Salivary duct dilationComplicated procedure
- 42660 is also a salivary duct dilation service. Select 42665 when the operative service is duct ligation rather than dilation.
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
Fee sheets
Put 42665 and the rest of your codes on one sheet
Your codes at your locality, with payer contracts beside Medicare.
Build my fee sheet