Billing code 42409: Salivary cyst drainageMedicare rate & RVUs

Medicare pays $387.12 for 42409 nationally in the office and $210.43 in a hospital or facility. Local office rates run $341.08–$514.02.

Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.

What 42409 covers

An otolaryngologist or oral and maxillofacial surgeon may open a fluid-filled salivary cyst to decompress it and allow its contents to drain. A ranula arising in the floor of the mouth is a familiar clinical example. The service addresses drainage of the cyst; it is distinct from removing the cyst or excising a salivary gland. It may be performed in an operating room or another surgical setting, depending on the case.

Select this code when the operative record supports drainage rather than excision. Document the cyst’s location and the drainage performed; do not choose it solely because a salivary lesion was treated. CMS assigns a 90-day major-surgery global period, including the day-before preoperative visit and 90 days of related postoperative care. When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and the others are subject to the standard multiple-procedure reduction. An assistant at surgery may be paid. Modifier 50 is inappropriate; 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 42409 pays more and less

The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.

109 of 109 payment localities

42409 rates by state

Office rate range in each state. Select a state to see its payment localities.

How the 42409 rate is calculated

Each of 42409’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.

Payment rules and modifiers for 42409

42409 has a 90-day global period: related visits in that window are included in the surgery payment.

What modifiers do to the payment

When to use modifier 51

42409 compared with similar codes

How to choose

42408Salivary cyst

Choose 42409 when the operative service drains the cyst; choose 42408 when the cyst is excised.

42400Salivary biopsy

42400 describes needle sampling of a salivary gland. It is not the code for opening and draining a cyst.

42405Salivary gland biopsy

42405 describes incisional sampling of salivary gland tissue. Use 42409 when the documented treatment is cyst drainage rather than biopsy.

Codes related to 42409

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

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

Open CMS sourceHow we calculate rates