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CMS RVU26D · Effective 2026-10-01

42600 in Delaware

Office / nonfacility

$533.61

Base rate per service

Facility setting

$316.14

Base rate per service

Amounts below use the non-QP conversion factor for participating physicians. These are base physician payments before claim-level adjustments, not patient costs or total hospital charges.

Salivary gland surgery

About 42600: Surgical closure of salivary fistula

Surgical closure of an abnormal salivary tract, such as persistent leakage from a salivary gland or duct to the skin or oral surface.

This operation closes an abnormal tract through which saliva escapes from a salivary gland or duct, such as a persistent opening from a parotid-region fistula to the skin. An otolaryngologist, head and neck surgeon, or oral and maxillofacial surgeon may perform the repair, typically in an operating room. The surgeon identifies the fistulous tract and surgically closes it; this is distinct from simply dilating or ligating a salivary duct.

Report 42600 when the operative service is closure of the salivary fistula. The operative report should identify the fistula’s location and salivary source, describe the closure performed, and distinguish it from a duct repair or ligation. CMS assigns a 90-day global period, including the day-before preoperative visit and related postoperative care. When multiple procedures occur in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% multiple-procedure reduction. Modifier 50 is inappropriate. Assistant-at-surgery payment requires documented medical necessity; co-surgeons and team surgery are not permitted.

CMS billing rules for 42600

Global period
Major surgery with a 90-day global period: the day-before preoperative visit and 90 days of related postoperative care are included.
Multiple procedures
Standard multiple procedure reduction: the highest-valued procedure is paid in full and others at 50% when performed in the same session.
Bilateral procedures
Bilateral adjustment does not apply; the descriptor or anatomy makes modifier 50 inappropriate.
Assistant at surgery
Assistant at surgery is paid only with documentation of medical necessity.
Co-surgeons
Co-surgeons not permitted.
Team surgery
Team surgery not permitted.

Where the value comes from

  • Work RVU4.82 · 30%
  • Practice expense (office) RVU10.63 · 66%
  • Malpractice RVU0.70 · 4%

15

Medicare services in 2024 · #6072 by national volume

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.

42600 compared with similar codes

Office rates for Delaware, from the same CMS release.

42500

Duct repair

Salivary duct

$444.13

42500 describes suturing a salivary duct. Choose 42600 when the operative target is closure of an abnormal salivary fistula.

42505

Salivary duct repair

Secondary, complicated

$568.09

42505 is for repair of the salivary duct itself; 42600 is for surgically closing a fistulous tract.

42665

Salivary duct surgery

Duct interruption

$364.31

42665 describes salivary duct ligation. It differs from 42600, which closes the fistula rather than ligating the duct.

42650

Salivary duct dilation

Percutaneous approach

$76.00

42650 describes dilation of a salivary duct, not closure of a salivary fistula.

The same code, a different location

How does Delaware compare?

42600 across payment areas

Same release and payment basis · bars start at $0

  1. Delaware · This locality

    $533.61

  2. Los Angeles-Long Beach-Anaheim (Los Angeles/Orange Cnty)

    $603.14

    $69.53 higher than Delaware

  3. Dc + Md/Va Suburbs

    $613.96

    $80.35 higher than Delaware

  4. Miami

    $589.73

    $56.12 higher than Delaware

  5. Chicago

    $572.60

    $38.99 higher than Delaware

  6. Manhattan

    $620.95

    $87.34 higher than Delaware

  7. Alaska*

    $632.50

    $98.89 higher than Delaware

Other payment areas listed in Delaware appear first, followed by selected cross-country examples. The chart compares amounts, not distance.

Across 109 of 109 CMS payment localities with a supported office rate, 42600 ranges from $478.02 in Arkansas to $703.22 in San Jose-Sunnyvale-Santa Clara (San Benito Cnty). This is a geographic range, not an average.

The code’s RVUs stay the same in these comparisons. Geographic adjustments to work, practice expense and malpractice change the dollar amount. A city name alone may not identify the payment area for a service address.

Compare all 108 other payment areas

  • Alabama

    Alabama · 42600

    Office

    $484.90

    Facility

    $292.30

    $48.71 lower than Delaware for the office setting.

  • Arkansas

    Arkansas · 42600

    Office

    $478.02

    Facility

    $288.95

    $55.59 lower than Delaware for the office setting.

  • Arizona

    Arizona · 42600

    Office

    $525.05

    Facility

    $311.76

    $8.56 lower than Delaware for the office setting.

  • Bakersfield

    California · 42600

    Office

    $567.43

    Facility

    $326.18

    $33.82 higher than Delaware for the office setting.

  • Chico

    California · 42600

    Office

    $565.40

    Facility

    $324.16

    $31.79 higher than Delaware for the office setting.

  • El Centro

    California · 42600

    Office

    $565.51

    Facility

    $324.27

    $31.90 higher than Delaware for the office setting.

  • Fresno

    California · 42600

    Office

    $565.40

    Facility

    $324.16

    $31.79 higher than Delaware for the office setting.

  • Hanford-Corcoran

    California · 42600

    Office

    $565.40

    Facility

    $324.16

    $31.79 higher than Delaware for the office setting.

  • Madera

    California · 42600

    Office

    $565.40

    Facility

    $324.16

    $31.79 higher than Delaware for the office setting.

  • Merced

    California · 42600

    Office

    $565.40

    Facility

    $324.16

    $31.79 higher than Delaware for the office setting.

  • Modesto

    California · 42600

    Office

    $565.40

    Facility

    $324.16

    $31.79 higher than Delaware for the office setting.

  • Napa

    California · 42600

    Office

    $650.97

    Facility

    $360.86

    $117.36 higher than Delaware for the office setting.

  • Oxnard-Thousand Oaks-Ventura

    California · 42600

    Office

    $599.74

    Facility

    $339.56

    $66.13 higher than Delaware for the office setting.

  • Redding

    California · 42600

    Office

    $565.40

    Facility

    $324.16

    $31.79 higher than Delaware for the office setting.

  • Rest Of California

    California · 42600

    Office

    $565.40

    Facility

    $324.16

    $31.79 higher than Delaware for the office setting.

  • Riverside-San Bernardino-Ontario

    California · 42600

    Office

    $572.97

    Facility

    $331.73

    $39.36 higher than Delaware for the office setting.

  • Sacramento-Roseville-Folsom

    California · 42600

    Office

    $592.25

    Facility

    $336.25

    $58.64 higher than Delaware for the office setting.

  • Salinas

    California · 42600

    Office

    $590.02

    Facility

    $334.91

    $56.41 higher than Delaware for the office setting.

  • San Diego-Chula Vista-Carlsbad

    California · 42600

    Office

    $603.14

    Facility

    $339.88

    $69.53 higher than Delaware for the office setting.

  • San Francisco-Oakland-Berkeley (Marin Cnty)

    California · 42600

    Office

    $687.64

    Facility

    $377.28

    $154.03 higher than Delaware for the office setting.

  • San Francisco-Oakland-Berkeley (San Francisco/San Mateo/Alameda/Contra Costa Cnty)

    California · 42600

    Office

    $686.85

    Facility

    $376.49

    $153.24 higher than Delaware for the office setting.

  • San Jose-Sunnyvale-Santa Clara (San Benito Cnty)

    California · 42600

    Office

    $703.22

    Facility

    $385.82

    $169.61 higher than Delaware for the office setting.

  • San Jose-Sunnyvale-Santa Clara (Santa Clara Cnty)

    California · 42600

    Office

    $699.97

    Facility

    $382.57

    $166.36 higher than Delaware for the office setting.

  • San Luis Obispo-Paso Robles

    California · 42600

    Office

    $580.66

    Facility

    $329.96

    $47.05 higher than Delaware for the office setting.

  • Santa Cruz-Watsonville

    California · 42600

    Office

    $608.29

    Facility

    $340.86

    $74.68 higher than Delaware for the office setting.

  • Santa Maria-Santa Barbara

    California · 42600

    Office

    $592.02

    Facility

    $335.37

    $58.41 higher than Delaware for the office setting.

  • Santa Rosa-Petaluma

    California · 42600

    Office

    $614.36

    Facility

    $344.06

    $80.75 higher than Delaware for the office setting.

  • Stockton

    California · 42600

    Office

    $565.40

    Facility

    $324.16

    $31.79 higher than Delaware for the office setting.

  • Vallejo

    California · 42600

    Office

    $649.82

    Facility

    $359.72

    $116.21 higher than Delaware for the office setting.

  • Visalia

    California · 42600

    Office

    $565.40

    Facility

    $324.16

    $31.79 higher than Delaware for the office setting.

  • Yuba City

    California · 42600

    Office

    $565.40

    Facility

    $324.16

    $31.79 higher than Delaware for the office setting.

  • Colorado

    Colorado · 42600

    Office

    $558.96

    Facility

    $324.76

    $25.35 higher than Delaware for the office setting.

  • Connecticut

    Connecticut · 42600

    Office

    $574.89

    Facility

    $337.83

    $41.28 higher than Delaware for the office setting.

  • Fort Lauderdale

    Florida · 42600

    Office

    $562.93

    Facility

    $339.96

    $29.32 higher than Delaware for the office setting.

  • Rest Of Florida

    Florida · 42600

    Office

    $535.56

    Facility

    $325.14

    $1.95 higher than Delaware for the office setting.

  • Atlanta

    Georgia · 42600

    Office

    $550.29

    Facility

    $326.65

    $16.68 higher than Delaware for the office setting.

  • Rest Of Georgia

    Georgia · 42600

    Office

    $505.57

    Facility

    $309.23

    $28.04 lower than Delaware for the office setting.

  • Hawaii, Guam

    Hawaii · 42600

    Office

    $578.22

    Facility

    $327.96

    $44.61 higher than Delaware for the office setting.

  • Iowa

    Iowa · 42600

    Office

    $495.15

    Facility

    $293.74

    $38.46 lower than Delaware for the office setting.

  • Idaho

    Idaho · 42600

    Office

    $498.70

    Facility

    $296.20

    $34.91 lower than Delaware for the office setting.

  • East St. Louis

    Illinois · 42600

    Office

    $534.73

    Facility

    $332.23

    $1.12 higher than Delaware for the office setting.

  • Rest Of Illinois

    Illinois · 42600

    Office

    $521.70

    Facility

    $320.74

    $11.91 lower than Delaware for the office setting.

  • Suburban Chicago

    Illinois · 42600

    Office

    $568.19

    Facility

    $342.13

    $34.58 higher than Delaware for the office setting.

  • Indiana

    Indiana · 42600

    Office

    $501.49

    Facility

    $297.44

    $32.12 lower than Delaware for the office setting.

  • Kansas

    Kansas · 42600

    Office

    $493.74

    Facility

    $294.76

    $39.87 lower than Delaware for the office setting.

  • Kentucky

    Kentucky · 42600

    Office

    $498.03

    Facility

    $302.35

    $35.58 lower than Delaware for the office setting.

  • New Orleans

    Louisiana · 42600

    Office

    $521.66

    Facility

    $314.53

    $11.95 lower than Delaware for the office setting.

  • Rest Of Louisiana

    Louisiana · 42600

    Office

    $497.61

    Facility

    $302.81

    $36.00 lower than Delaware for the office setting.

  • Metropolitan Boston

    Massachusetts · 42600

    Office

    $612.33

    Facility

    $349.52

    $78.72 higher than Delaware for the office setting.

  • Rest Of Massachusetts

    Massachusetts · 42600

    Office

    $556.07

    Facility

    $324.29

    $22.46 higher than Delaware for the office setting.

  • Baltimore/Surr. Cntys

    Maryland · 42600

    Office

    $573.46

    Facility

    $337.28

    $39.85 higher than Delaware for the office setting.

  • Rest Of Maryland

    Maryland · 42600

    Office

    $543.38

    Facility

    $320.62

    $9.77 higher than Delaware for the office setting.

  • Rest Of Maine

    Maine · 42600

    Office

    $502.18

    Facility

    $299.68

    $31.43 lower than Delaware for the office setting.

  • Southern Maine

    Maine · 42600

    Office

    $527.60

    Facility

    $309.47

    $6.01 lower than Delaware for the office setting.

  • Detroit

    Michigan · 42600

    Office

    $543.04

    Facility

    $330.63

    $9.43 higher than Delaware for the office setting.

  • Rest Of Michigan

    Michigan · 42600

    Office

    $511.55

    Facility

    $310.59

    $22.06 lower than Delaware for the office setting.

  • Minnesota

    Minnesota · 42600

    Office

    $533.26

    Facility

    $306.77

    $0.35 lower than Delaware for the office setting.

  • Metropolitan Kansas City

    Missouri · 42600

    Office

    $517.23

    Facility

    $310.54

    $16.38 lower than Delaware for the office setting.

  • Metropolitan St. Louis

    Missouri · 42600

    Office

    $522.43

    Facility

    $312.88

    $11.18 lower than Delaware for the office setting.

  • Rest Of Missouri

    Missouri · 42600

    Office

    $489.82

    Facility

    $300.08

    $43.79 lower than Delaware for the office setting.

  • Mississippi

    Mississippi · 42600

    Office

    $483.97

    Facility

    $294.45

    $49.64 lower than Delaware for the office setting.

  • Montana**

    Montana · 42600

    Office

    $539.38

    Facility

    $319.27

    $5.77 higher than Delaware for the office setting.

  • North Carolina

    North Carolina · 42600

    Office

    $507.20

    Facility

    $301.83

    $26.41 lower than Delaware for the office setting.

  • North Dakota**

    North Dakota · 42600

    Office

    $525.54

    Facility

    $305.42

    $8.07 lower than Delaware for the office setting.

  • Nebraska

    Nebraska · 42600

    Office

    $497.54

    Facility

    $294.38

    $36.07 lower than Delaware for the office setting.

  • New Hampshire

    New Hampshire · 42600

    Office

    $551.06

    Facility

    $321.92

    $17.45 higher than Delaware for the office setting.

  • Northern Nj

    New Jersey · 42600

    Office

    $607.97

    Facility

    $352.64

    $74.36 higher than Delaware for the office setting.

  • Rest Of New Jersey

    New Jersey · 42600

    Office

    $580.80

    Facility

    $340.43

    $47.19 higher than Delaware for the office setting.

  • New Mexico

    New Mexico · 42600

    Office

    $514.65

    Facility

    $312.81

    $18.96 lower than Delaware for the office setting.

  • Nevada**

    Nevada · 42600

    Office

    $535.88

    Facility

    $315.54

    $2.27 higher than Delaware for the office setting.

  • Nyc Suburbs/Long Island

    New York · 42600

    Office

    $636.87

    Facility

    $375.16

    $103.26 higher than Delaware for the office setting.

  • Poughkpsie/N Nyc Suburbs

    New York · 42600

    Office

    $585.31

    Facility

    $344.29

    $51.70 higher than Delaware for the office setting.

  • Queens

    New York · 42600

    Office

    $624.68

    Facility

    $364.51

    $91.07 higher than Delaware for the office setting.

  • Rest Of New York

    New York · 42600

    Office

    $514.73

    Facility

    $305.62

    $18.88 lower than Delaware for the office setting.

  • Ohio

    Ohio · 42600

    Office

    $508.72

    Facility

    $307.76

    $24.89 lower than Delaware for the office setting.

  • Oklahoma

    Oklahoma · 42600

    Office

    $496.22

    Facility

    $299.66

    $37.39 lower than Delaware for the office setting.

  • Portland

    Oregon · 42600

    Office

    $575.43

    Facility

    $330.88

    $41.82 higher than Delaware for the office setting.

  • Rest Of Oregon

    Oregon · 42600

    Office

    $531.06

    Facility

    $311.83

    $2.55 lower than Delaware for the office setting.

  • Metropolitan Philadelphia

    Pennsylvania · 42600

    Office

    $561.39

    Facility

    $332.26

    $27.78 higher than Delaware for the office setting.

  • Rest Of Pennsylvania

    Pennsylvania · 42600

    Office

    $509.02

    Facility

    $306.96

    $24.59 lower than Delaware for the office setting.

  • Puerto Rico

    Puerto Rico · 42600

    Office

    $542.98

    Facility

    $320.45

    $9.37 higher than Delaware for the office setting.

  • Rhode Island

    Rhode Island · 42600

    Office

    $551.67

    Facility

    $324.30

    $18.06 higher than Delaware for the office setting.

  • South Carolina

    South Carolina · 42600

    Office

    $508.93

    Facility

    $305.55

    $24.68 lower than Delaware for the office setting.

  • South Dakota**

    South Dakota · 42600

    Office

    $523.90

    Facility

    $303.79

    $9.71 lower than Delaware for the office setting.

  • Tennessee

    Tennessee · 42600

    Office

    $496.29

    Facility

    $296.21

    $37.32 lower than Delaware for the office setting.

  • Austin

    Texas · 42600

    Office

    $557.67

    Facility

    $324.80

    $24.06 higher than Delaware for the office setting.

  • Beaumont

    Texas · 42600

    Office

    $505.81

    Facility

    $305.51

    $27.80 lower than Delaware for the office setting.

  • Brazoria

    Texas · 42600

    Office

    $532.37

    Facility

    $314.24

    $1.24 lower than Delaware for the office setting.

  • Dallas

    Texas · 42600

    Office

    $536.13

    Facility

    $316.90

    $2.52 higher than Delaware for the office setting.

  • Fort Worth

    Texas · 42600

    Office

    $532.89

    Facility

    $315.86

    $0.72 lower than Delaware for the office setting.

  • Galveston

    Texas · 42600

    Office

    $534.21

    Facility

    $315.63

    $0.60 higher than Delaware for the office setting.

  • Houston

    Texas · 42600

    Office

    $547.02

    Facility

    $328.45

    $13.41 higher than Delaware for the office setting.

  • Rest Of Texas

    Texas · 42600

    Office

    $519.05

    Facility

    $310.16

    $14.56 lower than Delaware for the office setting.

  • Utah

    Utah · 42600

    Office

    $515.74

    Facility

    $308.83

    $17.87 lower than Delaware for the office setting.

  • Virginia

    Virginia · 42600

    Office

    $526.51

    Facility

    $310.14

    $7.10 lower than Delaware for the office setting.

  • Virgin Islands

    United States Virgin Islands · 42600

    Office

    $542.98

    Facility

    $320.45

    $9.37 higher than Delaware for the office setting.

  • Vermont

    Vermont · 42600

    Office

    $524.32

    Facility

    $306.41

    $9.29 lower than Delaware for the office setting.

  • Rest Of Washington

    Washington · 42600

    Office

    $554.75

    Facility

    $322.97

    $21.14 higher than Delaware for the office setting.

  • Seattle (King Cnty)

    Washington · 42600

    Office

    $623.79

    Facility

    $353.71

    $90.18 higher than Delaware for the office setting.

  • Wisconsin

    Wisconsin · 42600

    Office

    $508.33

    Facility

    $297.47

    $25.28 lower than Delaware for the office setting.

  • West Virginia

    West Virginia · 42600

    Office

    $502.99

    Facility

    $311.71

    $30.62 lower than Delaware for the office setting.

  • Wyoming**

    Wyoming · 42600

    Office

    $533.35

    Facility

    $313.23

    $0.26 lower than Delaware for the office setting.

See how rates vary across the country

42600 · Office / nonfacility · Non-QP. Choose a state to explore its payment localities. A range means the amount varies within that state.

MEWIVTNHMTNDMNMINYMARIWAIDWYSDIAILINOHPANJCTORNVUTCONEMOKYWVVAMDDECAAZNMKSOKARTNNCSCDCTXLAMSALGAFLAKHI

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.

$478.02

$634.31

Color shows the midpoint of each state’s locality range.

View all state and territory rates as a table
State / territoryRate rangeLocalities
AK$632.501
AL$484.901
AR$478.021
AZ$525.051
CA$565.40–$703.2229
CO$558.961
CT$574.891
DC$613.961
DE$533.611
FL$535.56–$589.733
GA$505.57–$550.292
GU$578.221
HI$578.221
IA$495.151
ID$498.701
IL$521.70–$572.604
IN$501.491
KS$493.741
KY$498.031
LA$497.61–$521.662
MA$556.07–$612.332
MD$543.38–$613.963
ME$502.18–$527.602
MI$511.55–$543.042
MN$533.261
MO$489.82–$522.433
MS$483.971
MT$539.381
NC$507.201
ND$525.541
NE$497.541
NH$551.061
NJ$580.80–$607.972
NM$514.651
NV$535.881
NY$514.73–$636.875
OH$508.721
OK$496.221
OR$531.06–$575.432
PA$509.02–$561.392
PR$542.981
RI$551.671
SC$508.931
SD$523.901
TN$496.291
TX$505.81–$557.678
UT$515.741
VA$526.51–$613.962
VI$542.981
VT$524.321
WA$554.75–$623.792
WI$508.331
WV$502.991
WY$533.351

Explore 42600 on the national rate map →

Where does this rate apply?

Delaware is a Medicare payment area. Our Census mapping connects it to 79 cities and communities in Delaware, including the examples shown here.

Some communities span more than one payment area. Follow a city link to compare all of its mapped areas, or check the service-location ZIP above for an address-level starting point.

Browse all communities in Delaware →

Why are the office and facility amounts different?

For 42600 in Delaware, the physician’s office rate is $533.61 and the facility-setting rate is $316.14: a difference of $217.47.

The calculation uses a different practice-expense RVU for each setting. Both amounts here are physician fee-schedule amounts. The facility figure does not include a hospital’s separate charges, so this comparison does not tell you the total cost of receiving care in each setting.

See the inputs behind this difference →

Use this rate

What is a percentage of Medicare worth?

Turn a percentage into dollars for 42600 in Delaware. This uses the base rate on this page, so the locality and release stay consistent.

Reference amount per service

$586.97

$533.61 × 110% = $586.97

A contract may specify another Medicare year or additional adjustments. This is percentage arithmetic on the displayed base rate, not a claim adjudication.

Working with a whole code list?

Compare an offer across your annual code mix, including an older Medicare schedule or flat per-code rates.

Compare your contract offer →

How this local rate is calculated

Each RVU component is multiplied by its own geographic practice cost index (GPCI). The three adjusted components are added, then multiplied by the conversion factor. These are the inputs used for 42600 in Delaware.

PPRRVU2026_Oct_nonQPP.csv

5,051

Code
42600
Physician work
4.82
Practice expense
10.63
Malpractice
0.70

GPCI2026.csv

40

Locality
Delaware
Physician work
1.005
Practice expense
0.988
Malpractice
0.899
Office / nonfacility calculation for 42600 in Delaware
ComponentRVULocality factorAdjusted
Physician work4.82× 1.0054.8441
Practice expense10.63× 0.98810.5024
Malpractice0.70× 0.8990.6293
Total RVUs15.9758
Conversion factor× 33.4009

Office / nonfacility rate, Delaware$533.61

Values as parsed from CMS release RVU26D, effective 2026-10-01. The amount is rounded to the nearest cent only at the end.

Open 42600 in the RVU calculator →

Explore RVUs, geographic factors and the full formula

Office / nonfacility

Office / nonfacility calculation inputs
ComponentRVULocal GPCI
Work4.821.005
Practice expense10.630.988
Malpractice0.70.899

(4.82 × 1.005 + 10.63 × 0.988 + 0.7 × 0.899) × $33.4009 = $533.61

Facility

Facility calculation inputs
ComponentRVULocal GPCI
Work4.821.005
Practice expense4.040.988
Malpractice0.70.899

(4.82 × 1.005 + 4.04 × 0.988 + 0.7 × 0.899) × $33.4009 = $316.14

The office and facility calculations use their respective practice-expense RVUs. The facility amount here is the physician fee, not a separate hospital or facility bill.

How this rate has changed

42600 · Office / nonfacility

$533.61

Effective 2026-10-01

The base rate is $8.21 higher than on 2025-10-01, moving from $525.40 to $533.61 (1.6%).

It is unchanged from the immediately preceding available release, effective 2026-07-01.

Base rate by release · bars start at $0 · select a bar to compare

One bar per available release, ordered by effective date. Missing rates remain gaps. These comparisons hold the code, setting and locality identifiers constant; they do not isolate which policy or input caused a change.

What changed, release by release

  1. January 1, 2026

    RVU26A

    $525.40changed to$533.61

    • Conversion factor 32.3465 changed to 33.4009
    • Work RVU 4.94 changed to 4.82
    • Practice expense RVU 10.67 changed to 10.63
    • Malpractice RVU 0.71 changed to 0.70
    • Work GPCI 1.009 changed to 1.005
    • Practice expense GPCI 0.992 changed to 0.988
    • Malpractice GPCI 0.949 changed to 0.899

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    Earliest loaded release: $525.40

    Held through RVU25B, RVU25C, RVU25D.

Explore release dates and calculate this code in an earlier period →

Each row uses the accepted CMS release effective on that date and the same contractor and locality identifiers. Missing rates stay visible. Historical boundaries may differ; verify the service address for an older claim.

Inspect every release and its CMS source
Effective fromOffice / nonfacilityFacilityCMS release
2026-10-01$533.61$316.14RVU26D
2026-07-01$533.61$316.14RVU26C
2026-04-01$533.61$316.14RVU26B
2026-01-01$533.61$316.14RVU26A
2025-10-01$525.40$349.88RVU25D
2025-07-01$525.40$349.88RVU25C
2025-04-01$525.40$349.88RVU25B
2025-01-01$525.40$349.88RVU25A

42600 billing questions

How is fistula closure different from salivary duct repair?

Use 42600 when the procedure closes an abnormal tract leaking saliva. Codes for duct repair describe repair of the duct itself, rather than closure of a fistula.

Is modifier 50 appropriate for bilateral fistula closure?

No. CMS identifies bilateral adjustment as inappropriate for this code.

What postoperative care is included?

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

When may an assistant-at-surgery be paid?

Payment is allowed only when the record documents medical necessity for the assistant.

Can co-surgeons or a surgical team be reported?

CMS does not permit co-surgeon or team-surgery payment for this code.

How is 42600 affected when other procedures are performed in the same session?

Under the standard multiple-procedure reduction, the highest-valued procedure is paid in full and the other procedures are paid at 50%.

Where these rates come from

FeeBase calculates base physician payments from CMS work, practice-expense, and malpractice RVUs, adjusted by each locality’s geographic indices and the applicable conversion factor. Unavailable or separately priced services are labeled rather than assigned a made-up amount.

Source: RVU26D. Effective 2026-10-01 through the day before 2027-01-01.

RVUs for 42600PPRRVU2026_Oct_nonQPP.csv, line 5,051 (RVU26D)
Geographic factors for DelawareGPCI2026.csv, line 40 (RVU26D)
Open CMS sourceHow this rate is calculatedBuild a fee sheet