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CPT code 42665: Salivary duct surgery, duct interruption2026 Medicare rate & RVUs in North Carolina

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 North Carolina, Medicare pays $345.73 for 42665 in the office and $186.17 when it’s performed in a hospital or facility.

$345.73Office (non-facility)
$186.17Hospital or facility
−6.2%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 North Carolina
  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 North Carolina 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. North Carolina pays $345.73. The RVUs are the same everywhere; the geographic indexes change the dollars.

42665 in North Carolina vs other payment areas
  1. North Carolina · this page$345.73
  2. Los Angeles, CA · California$417.10+$71.37
  3. Washington, DC area · District of Columbia$422.56+$76.83
  4. Miami, FL · Florida$398.90+$53.17
  5. Chicago, IL · Illinois$386.80+$41.07
  6. Manhattan, NY · New York$425.10+$79.37
  7. Alaska · Alaska$423.03+$77.30

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

Every other payment area

42665 in every other Medicare payment locality
Payment localityOfficeFacility
AlabamaAlabama$329.13$179.49
ArkansasArkansas$324.16$177.26
ArizonaArizona$358.21$192.50
Bakersfield, CACalifornia$391.01$203.58
Chico, CACalifornia$389.92$202.49
El Centro, CACalifornia$389.98$202.55
Fresno, CACalifornia$389.92$202.49
Hanford, CACalifornia$389.92$202.49

42665 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.

$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 North Carolina 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

83

Locality
North Carolina
Physician work
1.000
Practice expense
0.933
Malpractice
0.639
Office calculation for 42665 in North Carolina
ComponentRVULocality factorAdjusted
Physician work2.56× 1.0002.5600
Practice expense8.09× 0.9337.5480
Malpractice0.38× 0.6390.2428
Total RVUs10.3508
Conversion factor× 33.4009

Office rate, North Carolina$345.73

Office: (2.56 × 1 + 8.09 × 0.933 + 0.38 × 0.639) × $33.4009 = $345.73

Facility: (2.56 × 1 + 2.97 × 0.933 + 0.38 × 0.639) × $33.4009 = $186.17

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

Codes related to 42665

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

Codes related to 42665
CodeHow it relatesOffice range, North Carolina
Used instead
42650Salivary duct dilation, percutaneous approachDilation treats a narrowed salivary duct by opening it rather than interrupting flow.$72.27
42660Salivary duct dilation, complicated procedureA salivary duct dilation service; choose it when the duct is dilated rather than ligated.$96.25
42600Fistula closure, salivary tractDirectly closes a salivary fistula instead of ligating a duct.$507.20
42699Salivary procedure, unlisted procedureUnlisted salivary gland or duct procedure when no specific listed code describes the service.No office rate

How 42665 has changed in North Carolina

42665 · Office / nonfacility

$345.73

Effective 2026-10-01

The base rate is $7.26 higher than on 2025-10-01, moving from $338.47 to $345.73 (2.1%).

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

    $338.47changed to$345.73

    • 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
    • Practice expense GPCI 0.926 changed to 0.933
    • Malpractice GPCI 0.665 changed to 0.639

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $353.87changed to$338.47

    • 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

    $348.09changed to$353.87

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $362.61changed to$348.09

    • 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
    • Practice expense GPCI 0.927 changed to 0.926
    • Malpractice GPCI 0.742 changed to 0.665

  5. January 1, 2023

    RVU23A

    $369.02changed to$362.61

    • Conversion factor 34.6062 changed to 33.8872
    • Practice expense RVU 8.33 changed to 8.41
    • Practice expense GPCI 0.928 changed to 0.927
    • Malpractice GPCI 0.819 changed to 0.742

    Held through RVU23B, RVU23C, RVU23D.

  6. January 1, 2022

    RVU22A

    $357.87changed to$369.02

    • 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

    Held through RVU22B, RVU22C, RVU22D.

  7. January 1, 2021

    RVU21A

    $334.05changed to$357.87

    • 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
    • Practice expense GPCI 0.930 changed to 0.928
    • Malpractice GPCI 0.757 changed to 0.819

    Held through RVU21B, RVU21C, RVU21D.

  8. January 1, 2020

    RVU20A

    $319.37changed to$334.05

    • 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
    • Practice expense GPCI 0.931 changed to 0.930
    • Malpractice GPCI 0.695 changed to 0.757

    Held through RVU20B, RVU20C, RVU20D.

  9. January 1, 2019

    RVU19A

    $302.01changed to$319.37

    • 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

    Held through RVU19B, RVU19C, RVU19D.

  10. January 1, 2018

    RVU18AR1

    $307.11changed to$302.01

    • 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
    • Malpractice GPCI 0.732 changed to 0.695

    Held through RVU18B, RVU18C, RVU18D.

  11. January 1, 2017

    RVU17A

    $303.29changed to$307.11

    • Conversion factor 35.8043 changed to 35.8887
    • Practice expense RVU 5.95 changed to 6.06
    • Malpractice RVU 0.40 changed to 0.39
    • Practice expense GPCI 0.930 changed to 0.931
    • Malpractice GPCI 0.768 changed to 0.732

    Held through RVU17B, RVU17C, RVU17D.

  12. January 1, 2016

    RVU16A

    $305.50changed to$303.29

    • Conversion factor 35.9335 changed to 35.8043
    • Practice expense RVU 6.00 changed to 5.95
    • Malpractice RVU 0.38 changed to 0.40

    Held through RVU16B, RVU16C, RVU16D.

  13. July 1, 2015

    RVU15C

    $303.98changed to$305.50

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  14. January 1, 2015

    RVU15A

    $307.87changed to$303.98

    • Conversion factor 35.8228 changed to 35.7547
    • Practice expense RVU 6.16 changed to 6.00
    • Malpractice RVU 0.33 changed to 0.38
    • Practice expense GPCI 0.929 changed to 0.930
    • Malpractice GPCI 0.732 changed to 0.768

    Held through RVU15B.

  15. January 1, 2014

    RVU14A

    $313.56changed to$307.87

    • Conversion factor 34.0230 changed to 35.8228
    • Practice expense RVU 6.85 changed to 6.16
    • Malpractice RVU 0.34 changed to 0.33
    • Practice expense GPCI 0.927 changed to 0.929
    • Malpractice GPCI 0.695 changed to 0.732

    Held through RVU14B, RVU14C, RVU14D.

  16. January 1, 2013

    RVU13AR

    Earliest loaded release: $313.56

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$345.73$186.17RVU26D
2026-07-01$345.73$186.17RVU26C
2026-04-01$345.73$186.17RVU26B
2026-01-01$345.73$186.17RVU26A
2025-10-01$338.47$202.49RVU25D
2025-07-01$338.47$202.49RVU25C
2025-04-01$338.47$202.49RVU25B
2025-01-01$338.47$202.49RVU25A
2024-10-01$353.87$207.15RVU24D
2024-07-01$353.87$207.15RVU24C
2024-04-01$353.87$207.15RVU24B
2024-03-09$353.87$207.15RVU24AR
2024-01-01$348.09$203.77RVU24A
2023-10-01$362.61$209.00RVU23D
2023-07-01$362.61$209.00RVU23C
2023-04-01$362.61$209.00RVU23B
2023-01-01$362.61$209.00RVU23A
2022-10-01$369.02$209.41RVU22D
2022-07-01$369.02$209.41RVU22C
2022-04-01$369.02$209.41RVU22B
2022-01-01$369.02$209.41RVU22A
2021-10-01$357.87$205.03RVU21D
2021-07-01$357.87$205.03RVU21C
2021-04-01$357.87$205.03RVU21B
2021-01-01$357.87$205.03RVU21A
2020-10-01$334.05$204.83RVU20D
2020-07-01$334.05$204.83RVU20C
2020-04-01$334.05$204.83RVU20B
2020-01-01$334.05$204.83RVU20A
2019-10-01$319.37$203.28RVU19D
2019-07-01$319.37$203.28RVU19C
2019-04-01$319.37$203.28RVU19B
2019-01-01$319.37$203.28RVU19A
2018-10-01$302.01$200.46RVU18D
2018-07-01$302.01$200.46RVU18C
2018-04-01$302.01$200.46RVU18B
2018-01-01$302.01$200.46RVU18AR1
2017-10-01$307.11$204.54RVU17D
2017-07-01$307.11$204.54RVU17C
2017-04-01$307.11$204.54RVU17B
2017-01-01$307.11$204.54RVU17A
2016-10-01$303.29$203.06RVU16D
2016-07-01$303.29$203.06RVU16C
2016-04-01$303.29$203.06RVU16B
2016-01-01$303.29$203.06RVU16A
2015-10-01$305.50$204.24RVU15D
2015-07-01$305.50$204.24RVU15C
2015-04-01$303.98$203.23RVU15B
2015-01-01$303.98$203.23RVU15A
2014-10-01$307.87$204.70RVU14D
2014-07-01$307.87$204.70RVU14C
2014-04-01$307.87$204.70RVU14B
2014-01-01$307.87$204.70RVU14A
2013-10-01$313.56$204.12RVU13D
2013-07-01$313.56$204.12RVU13C
2013-04-01$313.56$204.12RVU13B
2013-01-01$313.56$204.12RVU13AR

Price 42665 for an earlier date of service

Where the North Carolina rate applies

North Carolina is a Medicare payment area, not a city. Our Census mapping connects it to 785 cities and communities in North Carolina. Some span more than one payment area; confirm with the service ZIP.

  • Aberdeen
  • Advance
  • Ahoskie
  • Alamance
  • Albemarle
  • Alexis
  • Alliance
  • Altamahaw

Browse all communities in North Carolina

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 North CarolinaGPCI2026.csv, line 83 (RVU26D)

Open CMS sourceHow we calculate rates

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