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Billing code 42426: ParotidectomyMedicare rate & RVUs

Total parotid removal with facial nerve dissection and unilateral radical neck dissection for cases requiring this combined operation.

CMS RVU26DEffective Oct 1, 2026109 payment localities175 Medicare services in 2024

Medicare pays $1,166.03 for 42426 nationally in a facility.

Medicare rate · 42426

Parotidectomy

Swap in your local Medicare rate.

Work RVUs
22.09
Total RVUs
34.91
Global days
090

National rate · 2026

$1,166.03

Facility setting, before claim adjustments.

See every locality for 42426 → · 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
  1. Medicare rate
  2. What 42426 covers
  3. By payment locality
  4. Rate map
  5. How it’s calculated
  6. Payment rules
  7. Similar codes
  8. Related codes
  9. Billing questions
  10. Sources

What 42426 covers

This operation removes the entire parotid gland and includes dissection and preservation of the facial nerve together with a unilateral radical neck dissection. It is typically performed by an otolaryngologist or head-and-neck surgeon in a hospital operating room for extensive parotid disease requiring treatment of cervical nodes. The operative report should establish the gland removal, nerve dissection and preservation, and neck dissection performed.

Report 42426 when the documented operation includes all of these elements, rather than a parotidectomy alone or a limited-lobe excision. The record should identify the side, extent of gland resection, facial nerve management, and extent of the neck dissection. CMS assigns a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. In a same-session multiple-procedure case, the highest-valued procedure is paid in full and other procedures at 50%. Modifier 50 is paid at 150% for bilateral performance. Assistant-at-surgery payment may be made; co-surgeon payment requires supporting documentation, and team surgery is 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 42426 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

42426 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$1,076.58
Alaska*Unavailable$1,503.03
ArizonaUnavailable$1,139.62
ArkansasUnavailable$1,065.66
AtlantaUnavailable$1,196.59
AustinUnavailable$1,172.34
BakersfieldUnavailable$1,164.54
Baltimore/Surr. CntysUnavailable$1,228.15
BeaumontUnavailable$1,129.70
BrazoriaUnavailable$1,143.55

42426 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.

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View every state and territory as a table
42426 office rate range by state
State / territoryOffice rate rangeLocalities
AKNo published base rate1
ALNo published base rate1
ARNo published base rate1
AZNo published base rate1
CANo published base rate29
CONo published base rate1
CTNo published base rate1
DCNo published base rate1
DENo published base rate1
FLNo published base rate3
GANo published base rate2
GUNo published base rate1
HINo published base rate1
IANo published base rate1
IDNo published base rate1
ILNo published base rate4
INNo published base rate1
KSNo published base rate1
KYNo published base rate1
LANo published base rate2
MANo published base rate2
MDNo published base rate3
MENo published base rate2
MINo published base rate2
MNNo published base rate1
MONo published base rate3
MSNo published base rate1
MTNo published base rate1
NCNo published base rate1
NDNo published base rate1
NENo published base rate1
NHNo published base rate1
NJNo published base rate2
NMNo published base rate1
NVNo published base rate1
NYNo published base rate5
OHNo published base rate1
OKNo published base rate1
ORNo published base rate2
PANo published base rate2
PRNo published base rate1
RINo published base rate1
SCNo published base rate1
SDNo published base rate1
TNNo published base rate1
TXNo published base rate8
UTNo published base rate1
VANo published base rate2
VINo published base rate1
VTNo published base rate1
WANo published base rate2
WINo published base rate1
WVNo published base rate1
WYNo published base rate1

How the 42426 rate is calculated

Each of 42426’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 · 42426

RVUs × geographic indexes × conversion factor

Swap in your local Medicare rate.

Work 22.09Practice expense 9.34Malpractice 3.48

34.9100 adjusted RVUs×$33.4009 conversion factor=$1,166.03

All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.

Payment rules and modifiers for 42426

42426 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 42426

Parotidectomy

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)1Permitted with supporting documentation.
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 · 42426

Parotidectomy

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.

  • 24 Unrelated E/M visit by the same physician
  • 79 Unrelated procedure (starts its own global period)
  • 58 Staged, more extensive, or therapy procedure that was planned
  • 78 Unplanned 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

42426 without 50 · national facility

$1,166.03

Parotidectomy

42426-50 · Bilateral: 150%

$1,749.05

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

42426 compared with similar codes

Compare codes

42426 vs 42425 vs 42420 vs 42415: national Medicare rates

Swap in your local Medicare rate.

  • 42426
    Parotidectomy · 22.09 wRVU
    —
  • 42425
    Parotidectomy · 13.08 wRVU
    —
  • 42420
    Parotid excision · 19.04 wRVU
    —
  • 42415
    Parotid excision · 16.73 wRVU
    —

How to choose

42425Parotidectomy
Choose 42426 when total parotidectomy with facial nerve dissection and preservation is performed with a unilateral radical neck dissection. Choose 42425 for the parotid operation without that neck dissection.
42420Parotid excision
42420 describes total parotidectomy without facial nerve dissection and preservation. 42426 includes nerve dissection and preservation plus a unilateral radical neck dissection.
42415Parotid excision
42415 is for lateral-lobe parotid excision with facial nerve dissection and preservation. 42426 involves removal of the total parotid gland and a unilateral radical neck dissection.

Codes related to 42426

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

Codes related to 42426
CodeHow it relatesNational office range
Same family
42425ParotidectomyTotal parotidectomy with facial nerve dissection and preservation, without the radical neck dissection included here.No office rate
42420Parotid excisionTotal parotidectomy without facial nerve dissection and preservation.No office rate
42415Parotid excisionParotid excision limited to the lateral lobe, with facial nerve dissection and preservation.No office rate
42410Parotid excisionParotid excision limited to the lateral lobe, without facial nerve dissection and preservation.No office rate

42426 billing questions

How does 42426 differ from 42425?

42426 includes a unilateral radical neck dissection with total parotid removal and facial nerve dissection and preservation. Use 42425 when the documented total parotidectomy does not include that neck dissection.

Can the radical neck dissection be reported separately?

The neck dissection is part of the combined operation represented by 42426. Do not separately report the same neck dissection as an additional procedure.

What documentation supports 42426?

Document total parotid removal, facial nerve dissection and preservation, and the unilateral radical neck dissection. Identify the operative side and the extent of each component.

How is bilateral performance reported?

CMS lists this as a bilateral procedure; modifier 50 is paid at 150% when performed bilaterally.

What global period applies?

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

Can an assistant or co-surgeon be paid?

Assistant-at-surgery payment may be made. Co-surgeon payment requires supporting documentation; team surgery is 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
RVUs for 42426PPRRVU2026_Oct_nonQPP.csv, line 5,036 (RVU26D)

Open CMS sourceHow we calculate rates

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