Billing code 42815: Neck cyst excisionMedicare rate & RVUs

Medicare pays $478.30 for 42815 nationally in a facility.

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

What 42815 covers

An otolaryngologist or head and neck surgeon uses this code for removal of a branchial cleft cyst, vestige, or fistulous tract that extends below the hyoid bone. The operation may involve tracing and removing the tract through deeper neck tissues; the excised tissue is typically submitted for pathologic examination. These cases are commonly performed in an operating room rather than an office setting.

Choose this code when the operative findings and procedure document extension below the hyoid, distinguishing it from the more limited excision reported with 42810. The operative report should identify the lesion or tract, its extent, the dissection performed, and whether the procedure was unilateral or bilateral. A 90-day global period includes the day-before preoperative visit and related postoperative care. For multiple procedures in one session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% reduction. Bilateral reporting with modifier 50 is paid at 150%. Assistant-at-surgery payment may be available; co-surgeons require 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 42815 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

42815 rates by state

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

How the 42815 rate is calculated

Each of 42815’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 42815

42815 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 50

42815 compared with similar codes

How to choose

42810Neck cyst excision

42810 is the more limited branchial cleft cyst, remnant, or fistula excision. Choose 42815 when the documented lesion extends below the hyoid.

60280Duct lesion excision

60280 is used for a thyroglossal duct cyst or sinus. A branchial cleft cyst, vestige, or fistula extending below the hyoid is reported with 42815.

21555Mass excision

21555 describes excision of a subcutaneous neck soft-tissue tumor. It is not the code for removal of a branchial cleft cyst or tract.

21556Tumor excision

21556 describes excision of a deep neck soft-tissue tumor. Use 42815 when the documented lesion is a branchial cleft cyst, vestige, or fistula extending below the hyoid.

Codes related to 42815

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