Billing code 42400: Salivary biopsyMedicare rate & RVUs
Reports needle-based tissue sampling of a salivary gland to evaluate a gland abnormality, such as a palpable mass or suspected neoplasm.
Medicare pays $94.52 for 42400 nationally in the office and $47.76 in a hospital or facility. Local office rates run $83.86–$125.46.
Medicare rate · 42400
Salivary biopsy
Swap in your local Medicare rate.
- Work RVUs
- 0.76
- Total RVUs
- 2.83
- Global days
- 000
National rate · 2026
$94.52
Office setting, before claim adjustments.
See every locality for 42400 → · Billed by an NP, PA or therapist? →
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 10 sections
What 42400 covers
This service samples tissue from a salivary gland with a needle for pathologic evaluation, commonly when a clinician is assessing a palpable gland mass or another suspicious gland abnormality. Otolaryngologists and other physicians who evaluate head and neck lesions may perform it in an office or facility setting. It is distinct from an incisional biopsy, which obtains tissue through an incision, and from fine-needle aspiration services that collect cells for cytology.
Report the biopsy when documentation supports needle-based tissue sampling of the gland, including the site sampled and the clinical reason for evaluation. The 0-day global period includes same-day preoperative and postoperative care. When multiple procedures are performed in one session, the highest-valued procedure is paid in full and the others are subject to the standard 50% multiple-procedure reduction. Modifier 50 is inappropriate. Medicare does not pay an assistant at surgery, and co-surgeons and team surgery are not permitted for this service.
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 42400 pays more and less
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
109 payment localities
$83.86 to $125.46
109 of 109 payment localities
42400 rates by state
Office rate range in each state. Select a state to see its payment localities.
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Local rates. Clear comparisons.
Hover or focus a tile to see its rate range. Select it to open the state’s fee schedule.
$83.86
$112.78
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 | $110.34 | 1 |
| AL | $85.06 | 1 |
| AR | $83.86 | 1 |
| AZ | $92.08 | 1 |
| CA | $100.10–$125.46 | 29 |
| CO | $98.50 | 1 |
| CT | $100.71 | 1 |
| DC | $108.03 | 1 |
| DE | $93.58 | 1 |
| FL | $92.94–$101.34 | 3 |
| GA | $87.86–$96.20 | 2 |
| GU | $102.51 | 1 |
| HI | $102.51 | 1 |
| IA | $87.26 | 1 |
| ID | $87.80 | 1 |
| IL | $90.25–$98.56 | 4 |
| IN | $88.30 | 1 |
| KS | $86.82 | 1 |
| KY | $86.92 | 1 |
| LA | $86.77–$90.97 | 2 |
| MA | $97.91–$108.17 | 2 |
| MD | $95.36–$108.03 | 3 |
| ME | $88.20–$92.94 | 2 |
| MI | $89.09–$94.03 | 2 |
| MN | $94.57 | 1 |
| MO | $85.28–$91.34 | 3 |
| MS | $84.59 | 1 |
| MT | $94.52 | 1 |
| NC | $89.11 | 1 |
| ND | $92.94 | 1 |
| NE | $87.74 | 1 |
| NH | $96.92 | 1 |
| NJ | $101.91–$106.94 | 2 |
| NM | $89.54 | 1 |
| NV | $94.14 | 1 |
| NY | $90.41–$111.00 | 5 |
| OH | $88.76 | 1 |
| OK | $86.82 | 1 |
| OR | $93.47–$101.62 | 2 |
| PA | $88.93–$98.22 | 2 |
| PR | $95.22 | 1 |
| RI | $96.91 | 1 |
| SC | $89.07 | 1 |
| SD | $92.75 | 1 |
| TN | $87.24 | 1 |
| TX | $88.35–$98.13 | 8 |
| UT | $90.26 | 1 |
| VA | $92.61–$108.03 | 2 |
| VI | $95.22 | 1 |
| VT | $92.54 | 1 |
| WA | $97.74–$110.39 | 2 |
| WI | $89.88 | 1 |
| WV | $86.97 | 1 |
| WY | $93.83 | 1 |
How the 42400 rate is calculated
Each of 42400’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 · 42400
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 0.76Practice expense 1.99Malpractice 0.08
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 42400
The CMS indicators that decide how 42400 is paid alongside other services.
CMS payment indicators · 42400
Salivary biopsy
| 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
42400 without 51 · national office
$94.52
Salivary biopsy
42400-51 · Second procedure: 50%
$47.26
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%).
42400 compared with similar codes
Compare codes
42400 vs 42405 vs 10021 vs 10005: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 42405Salivary gland biopsy
- Choose 42400 for needle-based gland tissue sampling; 42405 describes obtaining the biopsy through an incision.
- 10021Fine needle aspiration
- 10021 is for fine-needle aspiration without imaging guidance, which collects cells for cytology; 42400 reports needle-based salivary gland tissue biopsy.
- 10005Ultrasound-guided FNA
- 10005 reports ultrasound-guided fine-needle aspiration. Use 42400 for needle-based tissue biopsy rather than aspiration cytology.
42400 billing questions
How does this differ from an incisional salivary gland biopsy?
42400 is for needle-based tissue sampling. Use 42405 when the physician obtains the biopsy through an incision.
Can this be reported for fine-needle aspiration?
Fine-needle aspiration services use the aspiration biopsy code set, such as 10021 without imaging guidance or 10005 with ultrasound guidance. Do not select 42400 solely because the target is a salivary gland.
Is same-day postoperative care included?
Yes. The 0-day global period includes same-day preoperative and postoperative care.
Can modifier 50 be used for biopsies on both sides?
No. The CMS bilateral adjustment does not apply to 42400, and modifier 50 is inappropriate.
How are other procedures in the same session paid?
The highest-valued procedure is paid in full, with the standard multiple-procedure reduction applied to the other procedures. Medicare does not pay an assistant at surgery for 42400; co-surgeons and team surgery are not permitted.
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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