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Billing code 42509: Parotid duct diversionMedicare rate & RVUs

Reports surgery that redirects both parotid ducts, commonly to manage persistent drooling associated with neurologic or swallowing disorders.

CMS RVU26DEffective Oct 1, 2026109 payment localities

Medicare pays $718.79 for 42509 nationally in a facility.

Medicare rate · 42509

Parotid duct diversion

Work RVUs
11.47
Total RVUs
21.52
Global days
090

National rate · 2026

$718.79

Facility setting, before claim adjustments.

See every locality for 42509 →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 42509 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 42509 covers

In bilateral parotid duct diversion, the surgeon reroutes the openings of both parotid ducts so saliva drains farther back in the mouth. Otolaryngologists and oral and maxillofacial surgeons may perform this operation for severe, persistent drooling, including in patients with neurologic conditions that impair saliva control. The service is performed in an operative setting and is distinct from repairing a damaged duct or injecting contrast to image the salivary system.

Report 42509 for the bilateral diversion service; the code is priced as bilateral, so modifier 50 does not increase payment. The operative report should establish that both parotid ducts were diverted and describe the work performed. The code has a 90-day global period, which includes 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 other procedures are subject to the standard 50% reduction. Assistant-at-surgery payment requires documented medical necessity; 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 42509 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

42509 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$659.59
Alaska*Unavailable$903.49
ArizonaUnavailable$702.08
ArkansasUnavailable$652.27
AtlantaUnavailable$735.63
AustinUnavailable$729.43
BakersfieldUnavailable$731.13
Baltimore/Surr. CntysUnavailable$758.57
BeaumontUnavailable$689.64
BrazoriaUnavailable$707.06

42509 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.

View every state and territory as a table
42509 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 42509 rate is calculated

Each of 42509’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 · 42509

RVUs × geographic indexes × conversion factor

Work11.47

11.47 RVUs× 1.000 GPCI

Practice expense8.38

8.38 RVUs× 1.000 GPCI

Malpractice1.67

1.67 RVUs× 1.000 GPCI

Adjusted RVUs

21.5200

Conversion factor

$33.4009

Medicare rate

$718.79

Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.

Payment rules and modifiers for 42509

42509 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 42509

Parotid duct diversion

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)2Already bilateral by definition: paid once at 100%.
Assistant at surgery (80/81/82/AS)0Not paid without supporting documentation.
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 · 42509

Parotid duct diversion

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 51 · payment effect

With and without the modifier

42509 without 51 · national facility

$718.79

Parotid duct diversion

42509-51 · Second procedure: 50%

$359.40

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%).

When to use modifier 51

42509 compared with similar codes

Compare codes · National

5 codes, side by side

  • 42509

    Parotid duct diversion11.47 wRVU

    Not priced

  • 42507

    Parotid duct diversion6.09 wRVU

    Not priced

  • 42510

    Parotid duct diversion8.14 wRVU

    Not priced

  • 42500

    Duct repair4.31 wRVU

    $448.91

  • 42505

    Salivary duct repair6.16 wRVU

    $574.16

How to choose

42507Parotid duct diversion
Both codes concern parotid duct diversion. 42509 is priced as a bilateral service; use the code that matches the specific diversion performed and documented.
42510Parotid duct diversion
This is another code with a parotid duct diversion descriptor. Check the full descriptor and operative details rather than treating it as interchangeable with bilateral 42509.
42500Duct repair
42500 reports salivary duct repair. Choose it when the surgeon repairs a duct rather than rerouting both parotid duct openings.
42505Salivary duct repair
42505 is for a more involved salivary duct repair, not bilateral diversion of the parotid ducts.

Codes related to 42509

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

Codes related to 42509
CodeHow it relatesNational office range
Same family
42507Parotid duct diversionAnother parotid duct diversion code; distinguish the reported service using the applicable descriptor and operative documentation.No office rate
42510Parotid duct diversionA related parotid duct diversion code; confirm the specific procedure against its descriptor.No office rate
Used instead
42500Duct repairRepair of a salivary duct is a different service from diverting both parotid ducts.$398.79–$580.77
42505Salivary duct repairA more involved salivary duct repair is not a substitute for bilateral parotid duct diversion.$511.87–$732.40

42509 billing questions

When should 42509 be chosen over 42507?

Use 42509 when the operative service diverts both parotid ducts. The related 42507 code is another parotid duct diversion code; select based on the specific procedure documented and the applicable code descriptor.

Should modifier 50 be appended?

No. 42509 is already priced as bilateral, and modifier 50 does not increase payment.

What documentation supports reporting 42509?

The operative report should identify diversion of both parotid ducts and describe the surgical work. Documentation of drooling or a neurologic condition alone does not establish that the bilateral diversion was performed.

Are related postoperative visits included?

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

Can an assistant surgeon or co-surgeon be reported?

Assistant-at-surgery payment is available only when medical necessity is documented. Co-surgeons and team surgery are not permitted for this code.

How does the multiple-procedure reduction affect 42509?

When it is performed with other procedures in the same session, the highest-valued procedure is paid in full and the other procedures are subject to the standard 50% reduction.

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 42509PPRRVU2026_Oct_nonQPP.csv, line 5,045 (RVU26D)

Open CMS sourceHow we calculate rates

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