Billing code 42505: Salivary duct repairMedicare rate & RVUs
Reports complex secondary reconstruction of a salivary duct, such as repair of a scarred or injured duct when a simple primary procedure is insufficient.
Medicare pays $574.16 for 42505 nationally in the office and $410.16 in a hospital or facility. Local office rates run $511.87–$732.40.
Medicare rate · 42505
Salivary duct repair
Swap in your local Medicare rate.
- Work RVUs
- 6.16
- Total RVUs
- 17.19
- Global days
- 090
National rate · 2026
$574.16
Office setting, before claim adjustments.
See every locality for 42505 → · 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 42505 covers
This service involves complex reconstruction of a salivary duct after an earlier procedure, injury, or disease has left the duct damaged or scarred. The surgeon restores duct continuity or function through a secondary repair; the work may involve reconstructing or repositioning the duct. Otolaryngologists and oral and maxillofacial surgeons typically perform it in an operating room, including for parotid or other major salivary duct problems.
Choose this code when the operative work is a complicated secondary repair, rather than a simple primary duct procedure. Document the reason for secondary reconstruction, the condition of the duct, and the repair performed. The day-before preoperative visit and related postoperative care through day 90 are included in the global period. When other 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. Medicare does not pay an assistant at surgery for this service under the statutory restriction; 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 42505 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
$511.87 to $732.40
109 of 109 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Alabama | $518.82 | $375.32 |
| Alaska* | $685.53 | $510.87 |
| Arizona | $559.34 | $400.43 |
| Arkansas | $511.87 | $371.00 |
| Atlanta | $586.23 | $419.61 |
| Austin | $590.77 | $417.26 |
| Bakersfield | $598.80 | $419.06 |
| Baltimore/Surr. Cntys | $609.28 | $433.31 |
| Beaumont | $541.58 | $392.34 |
| Brazoria | $566.15 | $403.63 |
| Chicago | $616.22 | $451.40 |
| Chico | $596.19 | $416.45 |
| Colorado | $591.70 | $417.21 |
| Connecticut | $610.64 | $434.02 |
| Dallas | $570.39 | $407.05 |
| Dc + Md/Va Suburbs | $648.90 | $455.71 |
| Delaware | $568.09 | $406.06 |
| Detroit | $582.94 | $424.68 |
| East St. Louis | $577.58 | $426.70 |
| El Centro | $596.34 | $416.60 |
| Fort Lauderdale | $602.85 | $436.72 |
| Fort Worth | $567.40 | $405.70 |
| Fresno | $596.19 | $416.45 |
| Galveston | $568.27 | $405.42 |
| Hanford-Corcoran | $596.19 | $416.45 |
| Hawaii, Guam | $607.86 | $421.39 |
| Houston | $584.74 | $421.89 |
| Idaho | $531.25 | $380.37 |
| Indiana | $534.01 | $381.98 |
| Iowa | $527.27 | $377.22 |
| Kansas | $526.77 | $378.52 |
| Kentucky | $534.05 | $388.25 |
| Los Angeles-Long Beach-Anaheim (Los Angeles/Orange Cnty) | $634.42 | $440.40 |
| Madera | $596.19 | $416.45 |
| Manhattan | $659.76 | $469.19 |
| Merced | $596.19 | $416.45 |
| Metropolitan Boston | $644.93 | $449.12 |
| Metropolitan Kansas City | $552.83 | $398.84 |
| Metropolitan Philadelphia | $597.54 | $426.82 |
| Metropolitan St. Louis | $557.98 | $401.85 |
| Miami | $634.00 | $463.27 |
| Minnesota | $562.81 | $394.06 |
| Mississippi | $519.28 | $378.08 |
| Modesto | $596.19 | $416.45 |
| Montana** | $574.10 | $410.10 |
| Napa | $679.93 | $463.78 |
| Nebraska | $529.41 | $378.04 |
| Nevada** | $569.48 | $405.32 |
| New Hampshire | $584.28 | $413.55 |
| New Mexico | $552.12 | $401.73 |
| New Orleans | $558.29 | $403.96 |
| North Carolina | $540.64 | $387.63 |
| North Dakota** | $556.31 | $392.31 |
| Northern Nj | $643.30 | $453.07 |
| Nyc Suburbs/Long Island | $677.04 | $482.05 |
| Ohio | $544.97 | $395.23 |
| Oklahoma | $531.25 | $384.80 |
| Oxnard-Thousand Oaks-Ventura | $630.17 | $436.32 |
| Portland | $607.31 | $425.11 |
| Poughkpsie/N Nyc Suburbs | $621.88 | $442.30 |
| Puerto Rico | $577.43 | $411.63 |
| Queens | $662.20 | $468.35 |
| Redding | $596.19 | $416.45 |
| Rest Of California | $596.19 | $416.45 |
| Rest Of Florida | $574.39 | $417.61 |
| Rest Of Georgia | $543.39 | $397.10 |
| Rest Of Illinois | $561.65 | $411.92 |
| Rest Of Louisiana | $533.99 | $388.85 |
| Rest Of Maine | $535.73 | $384.85 |
| Rest Of Maryland | $577.81 | $411.85 |
| Rest Of Massachusetts | $589.28 | $416.59 |
| Rest Of Michigan | $548.60 | $398.87 |
| Rest Of Missouri | $526.69 | $385.32 |
| Rest Of New Jersey | $616.44 | $437.35 |
| Rest Of New York | $548.32 | $392.52 |
| Rest Of Oregon | $563.88 | $400.54 |
| Rest Of Pennsylvania | $544.76 | $394.21 |
| Rest Of Texas | $553.99 | $398.36 |
| Rest Of Washington | $587.58 | $414.89 |
| Rhode Island | $585.99 | $416.58 |
| Riverside-San Bernardino-Ontario | $605.93 | $426.19 |
| Sacramento-Roseville-Folsom | $622.77 | $432.04 |
| Salinas | $620.39 | $430.32 |
| San Diego-Chula Vista-Carlsbad | $632.88 | $436.74 |
| San Francisco-Oakland-Berkeley (Marin Cnty) | $716.17 | $484.93 |
| San Francisco-Oakland-Berkeley (San Francisco/San Mateo/Alameda/Contra Costa Cnty) | $715.15 | $483.91 |
| San Jose-Sunnyvale-Santa Clara (San Benito Cnty) | $732.40 | $495.91 |
| San Jose-Sunnyvale-Santa Clara (Santa Clara Cnty) | $728.22 | $491.73 |
| San Luis Obispo-Paso Robles | $610.74 | $423.95 |
| Santa Cruz-Watsonville | $637.28 | $438.02 |
| Santa Maria-Santa Barbara | $622.14 | $430.92 |
| Santa Rosa-Petaluma | $643.53 | $442.14 |
| Seattle (King Cnty) | $655.75 | $454.53 |
| South Carolina | $543.94 | $392.40 |
| South Dakota** | $554.20 | $390.20 |
| Southern Maine | $560.02 | $397.50 |
| Stockton | $596.19 | $416.45 |
| Suburban Chicago | $607.94 | $439.52 |
| Tennessee | $529.45 | $380.38 |
| Utah | $550.79 | $396.64 |
| Vallejo | $678.46 | $462.31 |
| Vermont | $555.93 | $393.57 |
| Virgin Islands | $577.43 | $411.63 |
| Virginia | $559.57 | $398.36 |
| Visalia | $596.19 | $416.45 |
| West Virginia | $542.79 | $400.28 |
| Wisconsin | $539.15 | $382.04 |
| Wyoming** | $566.35 | $402.35 |
| Yuba City | $596.19 | $416.45 |
42505 rates by state
Office rate range in each state. Select a state to see its payment localities.
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.
$511.87
$685.53
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 | $685.53 | 1 |
| AL | $518.82 | 1 |
| AR | $511.87 | 1 |
| AZ | $559.34 | 1 |
| CA | $596.19–$732.40 | 29 |
| CO | $591.70 | 1 |
| CT | $610.64 | 1 |
| DC | $648.90 | 1 |
| DE | $568.09 | 1 |
| FL | $574.39–$634.00 | 3 |
| GA | $543.39–$586.23 | 2 |
| GU | $607.86 | 1 |
| HI | $607.86 | 1 |
| IA | $527.27 | 1 |
| ID | $531.25 | 1 |
| IL | $561.65–$616.22 | 4 |
| IN | $534.01 | 1 |
| KS | $526.77 | 1 |
| KY | $534.05 | 1 |
| LA | $533.99–$558.29 | 2 |
| MA | $589.28–$644.93 | 2 |
| MD | $577.81–$648.90 | 3 |
| ME | $535.73–$560.02 | 2 |
| MI | $548.60–$582.94 | 2 |
| MN | $562.81 | 1 |
| MO | $526.69–$557.98 | 3 |
| MS | $519.28 | 1 |
| MT | $574.10 | 1 |
| NC | $540.64 | 1 |
| ND | $556.31 | 1 |
| NE | $529.41 | 1 |
| NH | $584.28 | 1 |
| NJ | $616.44–$643.30 | 2 |
| NM | $552.12 | 1 |
| NV | $569.48 | 1 |
| NY | $548.32–$677.04 | 5 |
| OH | $544.97 | 1 |
| OK | $531.25 | 1 |
| OR | $563.88–$607.31 | 2 |
| PA | $544.76–$597.54 | 2 |
| PR | $577.43 | 1 |
| RI | $585.99 | 1 |
| SC | $543.94 | 1 |
| SD | $554.20 | 1 |
| TN | $529.45 | 1 |
| TX | $541.58–$590.77 | 8 |
| UT | $550.79 | 1 |
| VA | $559.57–$648.90 | 2 |
| VI | $577.43 | 1 |
| VT | $555.93 | 1 |
| WA | $587.58–$655.75 | 2 |
| WI | $539.15 | 1 |
| WV | $542.79 | 1 |
| WY | $566.35 | 1 |
How the 42505 rate is calculated
Each of 42505’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 · 42505
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 6.16Practice expense 10.13Malpractice 0.90
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 42505
42505 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 42505
Salivary duct repair
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 090 | Major surgery: the day before, the day of, and 90 days after are 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. |
| Split (54/55/56) | 0.09/0.81/0.10 | Share of the payment for pre-op, the procedure itself, and post-op care. |
Global surgery period · 42505
Salivary duct repair
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.
Pre-op dayGlobal period
What modifiers do to the payment
Modifier 51 · payment effect
With and without the modifier
42505 without 51 · national office
$574.16
Salivary duct repair
42505-51 · Second procedure: 50%
$287.08
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%).
42505 compared with similar codes
Compare codes
42505 vs 42500 vs 42507 vs 42509: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 42500Duct repair
- 42500 is for a simple primary salivary duct procedure. Use 42505 when the surgeon performs complicated secondary reconstruction.
- 42507Parotid duct diversion
- 42507 describes parotid duct transposition. Choose 42505 for complicated secondary repair of the duct rather than a procedure whose goal is transposition.
- 42509Parotid duct diversion
- 42509 is a parotid duct diversion procedure. The operative objective is diversion, whereas 42505 represents complicated secondary duct repair.
42505 billing questions
How does this differ from 42500?
Use 42505 for a complicated secondary repair, such as reconstruction of a previously treated or scarred duct. Code 42500 describes a simple primary duct procedure.
Is postoperative care separately reportable?
Related postoperative care through day 90 is included in the global period, along with the day-before preoperative visit.
Can modifier 50 be used?
No. The descriptor and anatomy make modifier 50 inappropriate for this code.
Can an assistant surgeon or co-surgeon be reported?
Medicare does not pay an assistant at surgery for this service under the statutory restriction. Co-surgeons and team surgery are not permitted.
How is this paid with another procedure in the same session?
The highest-valued procedure is paid in full; other procedures in the same session are subject to the standard 50% multiple-procedure reduction.
What documentation supports choosing 42505?
Describe why secondary reconstruction was needed, the duct's condition, and the operative repair. The record should support complicated secondary work rather than a simple primary procedure.
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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