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CPT code 42810: Neck cyst excision, confined to skin and subcutaneous tissue2026 Medicare rate & RVUs in North Carolina

Reports removal of a superficial branchial cleft cyst or remnant confined to the skin and subcutaneous tissue, without deeper extension.

CMS RVU26DEffective Oct 1, 2026One payment locality45 Medicare services in 2024

In North Carolina, Medicare pays $363.01 for 42810 in the office and $243.35 when it’s performed in a hospital or facility.

$363.01Office (non-facility)
$243.35Hospital or facility
−6.0%vs the national office rate ($386.11)

Check a contract rate as a % of Medicare · 42810 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 42810 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in North Carolina
  2. What 42810 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 42810 covers

This code describes surgical removal of a branchial cleft cyst or remnant when it is limited to the skin and tissue just beneath it. Otolaryngologists and other surgeons may perform the procedure for a congenital neck lump or draining opening attributable to a superficial branchial cleft remnant. The operative report should identify the lesion and its location and show that its extent remained within the skin and subcutaneous tissues.

Choose this code based on the documented depth and extent, not simply the diagnosis of a neck cyst. A remnant extending deeper than the subcutaneous tissues or into the pharynx points to 42815 instead. The procedure has a 90-day global period, including the day-before preoperative visit and related postoperative care during that period. 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% reduction. For bilateral procedures, modifier 50 is paid at 150%. Assistant-at-surgery payment may be available; 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 42810

Across 109 of 109 payment localities, the office rate for 42810 runs from $341.81 in Arkansas to $505.96 in San Benito County, CA. North Carolina pays $363.01. The RVUs are the same everywhere; the geographic indexes change the dollars.

42810 in North Carolina vs other payment areas
  1. North Carolina · this page$363.01
  2. Los Angeles, CA · California$432.97+$69.96
  3. Washington, DC area · District of Columbia$440.15+$77.14
  4. Miami, FL · Florida$420.79+$57.78
  5. Chicago, IL · Illinois$408.52+$45.51
  6. Manhattan, NY · New York$444.52+$81.51
  7. Alaska · Alaska$451.09+$88.08

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

Every other payment area

42810 in every other Medicare payment locality
Payment localityOfficeFacility
AlabamaAlabama$346.78$234.55
ArkansasArkansas$341.81$231.64
ArizonaArizona$375.79$251.50
Bakersfield, CACalifornia$407.05$266.48
Chico, CACalifornia$405.68$265.11
El Centro, CACalifornia$405.76$265.19
Fresno, CACalifornia$405.68$265.11
Hanford, CACalifornia$405.68$265.11

42810 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.

$341.81

$455.82

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

View every state and territory as a table
42810 office rate range by state
State / territoryOffice rate rangeLocalities
AK$451.091
AL$346.781
AR$341.811
AZ$375.791
CA$405.68–$505.9629
CO$400.651
CT$411.651
DC$440.151
DE$381.961
FL$382.56–$420.793
GA$361.03–$393.762
GU$415.151
HI$415.151
IA$354.531
ID$357.031
IL$372.32–$408.524
IN$359.051
KS$353.351
KY$355.901
LA$355.53–$372.902
MA$398.48–$439.382
MD$389.05–$440.153
ME$359.36–$377.982
MI$365.50–$387.782
MN$382.611
MO$349.80–$373.663
MS$345.851
MT$386.081
NC$363.011
ND$376.791
NE$356.321
NH$394.821
NJ$415.98–$435.762
NM$367.671
NV$383.751
NY$368.44–$455.805
OH$363.601
OK$354.771
OR$380.41–$412.742
PA$363.92–$401.802
PR$388.741
RI$395.101
SC$363.981
SD$375.691
TN$355.171
TX$361.58–$399.648
UT$368.901
VA$377.08–$440.152
VI$388.741
VT$375.761
WA$397.59–$447.822
WI$364.321
WV$358.801
WY$382.031

See 42810 in every payment locality

How the 42810 rate is calculated

Each of 42810’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 · 42810

RVUs × geographic indexes × conversion factor

Office or facility?

Work3.30

3.30 RVUs× 1.000 GPCI

Practice expense7.79

7.79 RVUs× 1.000 GPCI

Malpractice0.47

0.47 RVUs× 1.000 GPCI

Adjusted RVUs

11.5600

Conversion factor

$33.4009

Medicare rate

$386.11

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

5,077

Code
42810
Physician work
3.30
Practice expense
7.79
Malpractice
0.47

GPCI2026.csv

83

Locality
North Carolina
Physician work
1.000
Practice expense
0.933
Malpractice
0.639
Office calculation for 42810 in North Carolina
ComponentRVULocality factorAdjusted
Physician work3.30× 1.0003.3000
Practice expense7.79× 0.9337.2681
Malpractice0.47× 0.6390.3003
Total RVUs10.8684
Conversion factor× 33.4009

Office rate, North Carolina$363.01

Office: (3.3 × 1 + 7.79 × 0.933 + 0.47 × 0.639) × $33.4009 = $363.01

Facility: (3.3 × 1 + 3.95 × 0.933 + 0.47 × 0.639) × $33.4009 = $243.35

Open 42810 in the RVU calculator

Payment rules and modifiers for 42810

42810 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 42810

Neck cyst excision, confined to skin and subcutaneous tissue

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)1Bilateral with modifier 50 pays 150% of the fee schedule amount.
Assistant at surgery (80/81/82/AS)2Paid.
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 · 42810

Neck cyst excision, confined to skin and subcutaneous tissue

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 50 · payment effect

With and without the modifier

42810 without 50 · national office

$386.11

Neck cyst excision, confined to skin and subcutaneous tissue

42810-50 · Bilateral: 150%

$579.17

Both sides on one line with modifier 50 are paid at 150% of the fee schedule amount (subject to multiple-procedure rules with other procedures).

When to use modifier 50

Codes related to 42810

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

Codes related to 42810
CodeHow it relatesOffice range, North Carolina
Same family
42815Neck cyst excision, extending below hyoidFor branchial cleft remnants extending deeper than subcutaneous tissue or into the pharynx.No office rate
Used instead
60281Duct lesion excision, with hyoid bone resectionFor removal of a primary thyroglossal duct cyst or sinus rather than a branchial cleft remnant.No office rate
21555Mass excision, subcutaneous, under 3 cmFor excision of a qualifying superficial soft-tissue mass of the neck, rather than a branchial cleft remnant.$432.19

How 42810 has changed in North Carolina

42810 · Office / nonfacility

$363.01

Effective 2026-10-01

The base rate is $8.09 higher than on 2025-10-01, moving from $354.92 to $363.01 (2.3%).

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

    $354.92changed to$363.01

    • Conversion factor 32.3465 changed to 33.4009
    • Work RVU 3.38 changed to 3.30
    • Practice expense RVU 7.84 changed to 7.79
    • Malpractice RVU 0.50 changed to 0.47
    • 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

    $368.41changed to$354.92

    • Conversion factor 33.2875 changed to 32.3465
    • Practice expense RVU 7.95 changed to 7.84
    • Malpractice RVU 0.49 changed to 0.50

    Held through RVU25B, RVU25C, RVU25D.

  3. March 9, 2024

    RVU24AR

    $362.40changed to$368.41

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $375.47changed to$362.40

    • Conversion factor 33.8872 changed to 32.7442
    • Practice expense RVU 7.93 changed to 7.95
    • Malpractice RVU 0.47 changed to 0.49
    • Practice expense GPCI 0.927 changed to 0.926
    • Malpractice GPCI 0.742 changed to 0.665

  5. January 1, 2023

    RVU23A

    $380.14changed to$375.47

    • Conversion factor 34.6062 changed to 33.8872
    • Practice expense RVU 7.78 changed to 7.93
    • 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

    $381.39changed to$380.14

    • Conversion factor 34.8931 changed to 34.6062
    • Practice expense RVU 7.73 changed to 7.78
    • Malpractice RVU 0.46 changed to 0.47

    Held through RVU22B, RVU22C, RVU22D.

  7. January 1, 2021

    RVU21A

    $374.80changed to$381.39

    • Conversion factor 36.0896 changed to 34.8931
    • Practice expense RVU 7.15 changed to 7.73
    • Malpractice RVU 0.47 changed to 0.46
    • 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

    $375.41changed to$374.80

    • Conversion factor 36.0391 changed to 36.0896
    • Practice expense RVU 7.20 changed to 7.15
    • Malpractice RVU 0.48 changed to 0.47
    • 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

    $373.91changed to$375.41

    • Conversion factor 35.9996 changed to 36.0391
    • Practice expense RVU 7.16 changed to 7.20
    • Malpractice RVU 0.49 changed to 0.48

    Held through RVU19B, RVU19C, RVU19D.

  10. January 1, 2018

    RVU18AR1

    $376.08changed to$373.91

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 7.24 changed to 7.16
    • Malpractice GPCI 0.732 changed to 0.695

    Held through RVU18B, RVU18C, RVU18D.

  11. January 1, 2017

    RVU17A

    $380.56changed to$376.08

    • Conversion factor 35.8043 changed to 35.8887
    • Practice expense RVU 7.39 changed to 7.24
    • 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

    $381.21changed to$380.56

    • Conversion factor 35.9335 changed to 35.8043
    • Practice expense RVU 7.36 changed to 7.39
    • Malpractice RVU 0.50 changed to 0.49

    Held through RVU16B, RVU16C, RVU16D.

  13. July 1, 2015

    RVU15C

    $379.31changed to$381.21

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  14. January 1, 2015

    RVU15A

    $380.50changed to$379.31

    • Conversion factor 35.8228 changed to 35.7547
    • Practice expense RVU 7.48 changed to 7.36
    • Malpractice RVU 0.40 changed to 0.50
    • 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

    $387.02changed to$380.50

    • Conversion factor 34.0230 changed to 35.8228
    • Practice expense RVU 8.31 changed to 7.48
    • Malpractice RVU 0.42 changed to 0.40
    • 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: $387.02

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$363.01$243.35RVU26D
2026-07-01$363.01$243.35RVU26C
2026-04-01$363.01$243.35RVU26B
2026-01-01$363.01$243.35RVU26A
2025-10-01$354.92$262.36RVU25D
2025-07-01$354.92$262.36RVU25C
2025-04-01$354.92$262.36RVU25B
2025-01-01$354.92$262.36RVU25A
2024-10-01$368.41$269.16RVU24D
2024-07-01$368.41$269.16RVU24C
2024-04-01$368.41$269.16RVU24B
2024-03-09$368.41$269.16RVU24AR
2024-01-01$362.40$264.76RVU24A
2023-10-01$375.47$272.74RVU23D
2023-07-01$375.47$272.74RVU23C
2023-04-01$375.47$272.74RVU23B
2023-01-01$375.47$272.74RVU23A
2022-10-01$380.14$274.48RVU22D
2022-07-01$380.14$274.48RVU22C
2022-04-01$380.14$274.48RVU22B
2022-01-01$380.14$274.48RVU22A
2021-10-01$381.39$274.21RVU21D
2021-07-01$381.39$274.21RVU21C
2021-04-01$381.39$274.21RVU21B
2021-01-01$381.39$274.21RVU21A
2020-10-01$374.80$277.47RVU20D
2020-07-01$374.80$277.47RVU20C
2020-04-01$374.80$277.47RVU20B
2020-01-01$374.80$277.47RVU20A
2019-10-01$375.41$279.45RVU19D
2019-07-01$375.41$279.45RVU19C
2019-04-01$375.41$279.45RVU19B
2019-01-01$375.41$279.45RVU19A
2018-10-01$373.91$280.40RVU18D
2018-07-01$373.91$280.40RVU18C
2018-04-01$373.91$280.40RVU18B
2018-01-01$373.91$280.40RVU18AR1
2017-10-01$376.08$283.20RVU17D
2017-07-01$376.08$283.20RVU17C
2017-04-01$376.08$283.20RVU17B
2017-01-01$376.08$283.20RVU17A
2016-10-01$380.56$286.00RVU16D
2016-07-01$380.56$286.00RVU16C
2016-04-01$380.56$286.00RVU16B
2016-01-01$380.56$286.00RVU16A
2015-10-01$381.21$285.97RVU15D
2015-07-01$381.21$285.97RVU15C
2015-04-01$379.31$284.55RVU15B
2015-01-01$379.31$284.55RVU15A
2014-10-01$380.50$285.65RVU14D
2014-07-01$380.50$285.65RVU14C
2014-04-01$380.50$285.65RVU14B
2014-01-01$380.50$285.65RVU14A
2013-10-01$387.02$286.09RVU13D
2013-07-01$387.02$286.09RVU13C
2013-04-01$387.02$286.09RVU13B
2013-01-01$387.02$286.09RVU13AR

Price 42810 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

42810 billing questions

How do I distinguish 42810 from 42815?

Use 42810 when the branchial cleft cyst or remnant is confined to skin and subcutaneous tissue. Use 42815 when the operative documentation describes extension beneath the subcutaneous tissues or into the pharynx.

What documentation supports 42810?

Document the branchial cleft origin, neck location, and operative findings showing the lesion remained within skin and subcutaneous tissue. The depth and extent of the excision distinguish this code from 42815.

What postoperative care is included?

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

How is 42810 handled with another procedure in the same session?

Under the standard multiple procedure reduction, the highest-valued procedure is paid in full and the other procedures are paid at 50%.

Can modifier 50 be used for bilateral excision?

The CMS bilateral rule specifies modifier 50, with payment at 150% for a bilateral procedure.

Can an assistant or co-surgeon be reported?

Assistant-at-surgery payment may be available. Co-surgeons and team surgery are not permitted for this code.

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 42810PPRRVU2026_Oct_nonQPP.csv, line 5,077 (RVU26D)
Geographic factors for North CarolinaGPCI2026.csv, line 83 (RVU26D)

Open CMS sourceHow we calculate rates

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