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CMS RVU26D · Effective 2026-10-01

42400 in Merced

Office / nonfacility

$100.10

Base rate per service

Facility setting

$48.85

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.

ENT procedure

About 42400: Salivary gland needle biopsy

Reports needle-based tissue sampling of a salivary gland to evaluate a gland abnormality, such as a palpable mass or suspected neoplasm.

This service samples tissue from a salivary gland with a needle for pathologic evaluation, commonly when a clinician is assessing a palpable gland mass or another suspicious gland abnormality. Otolaryngologists and other physicians who evaluate head and neck lesions may perform it in an office or facility setting. It is distinct from an incisional biopsy, which obtains tissue through an incision, and from fine-needle aspiration services that collect cells for cytology.

Report the biopsy when documentation supports needle-based tissue sampling of the gland, including the site sampled and the clinical reason for evaluation. The 0-day global period includes same-day preoperative and postoperative care. When multiple procedures are performed in one session, the highest-valued procedure is paid in full and the others are subject to the standard 50% multiple-procedure reduction. Modifier 50 is inappropriate. Medicare does not pay an assistant at surgery, and co-surgeons and team surgery are not permitted for this service.

CMS billing rules for 42400

Global period
Minor procedure with a 0-day global period: same-day preoperative and postoperative care is 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
Statutory restriction: assistant at surgery is not paid.
Co-surgeons
Co-surgeons not permitted.
Team surgery
Team surgery not permitted.

Where the value comes from

  • Work RVU0.76 · 27%
  • Practice expense (office) RVU1.99 · 70%
  • Malpractice RVU0.08 · 3%

3.6K

Medicare services in 2024 · #2054 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.

42400 compared with similar codes

Office rates for Merced, from the same CMS release.

42405

Salivary gland biopsy

Incisional tissue sampling

$319.22

Choose 42400 for needle-based gland tissue sampling; 42405 describes obtaining the biopsy through an incision.

10021

Fine needle aspiration

First lesion, no imaging

$105.30

10021 is for fine-needle aspiration without imaging guidance, which collects cells for cytology; 42400 reports needle-based salivary gland tissue biopsy.

10005

Ultrasound-guided FNA

First lesion

$138.04

10005 reports ultrasound-guided fine-needle aspiration. Use 42400 for needle-based tissue biopsy rather than aspiration cytology.

The same code, a different location

How does Merced compare?

In Bakersfield, the office rate for 42400 is $100.34—$0.24 higher than the $100.10 rate in Merced. Both use the same code, release and participation basis.

42400 across payment areas

Same release and payment basis · bars start at $0

  1. Merced · This locality

    $100.10

  2. Bakersfield

    $100.34

    $0.24 higher than Merced

  3. Chico

    $100.10

    The same base rate than Merced

  4. El Centro

    $100.11

    $0.01 higher than Merced

  5. Fresno

    $100.10

    The same base rate than Merced

  6. Hanford-Corcoran

    $100.10

    The same base rate than Merced

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

    $106.83

    $6.73 higher than Merced

Other payment areas listed in California 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, 42400 ranges from $83.86 in Arkansas to $125.46 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

  • Madera

    California · 42400

    Office

    $100.10

    Facility

    $48.85

    The same base rate than Merced for the office setting.

  • Modesto

    California · 42400

    Office

    $100.10

    Facility

    $48.85

    The same base rate than Merced for the office setting.

  • Napa

    California · 42400

    Office

    $115.95

    Facility

    $54.31

    $15.85 higher than Merced for the office setting.

  • Oxnard-Thousand Oaks-Ventura

    California · 42400

    Office

    $106.33

    Facility

    $51.05

    $6.23 higher than Merced for the office setting.

  • Redding

    California · 42400

    Office

    $100.10

    Facility

    $48.85

    The same base rate than Merced for the office setting.

  • Rest Of California

    California · 42400

    Office

    $100.10

    Facility

    $48.85

    The same base rate than Merced for the office setting.

  • Riverside-San Bernardino-Ontario

    California · 42400

    Office

    $100.97

    Facility

    $49.72

    $0.87 higher than Merced for the office setting.

  • Sacramento-Roseville-Folsom

    California · 42400

    Office

    $105.03

    Facility

    $50.65

    $4.93 higher than Merced for the office setting.

  • Salinas

    California · 42400

    Office

    $104.64

    Facility

    $50.44

    $4.54 higher than Merced for the office setting.

  • San Diego-Chula Vista-Carlsbad

    California · 42400

    Office

    $107.09

    Facility

    $51.16

    $6.99 higher than Merced for the office setting.

  • San Francisco-Oakland-Berkeley (Marin Cnty)

    California · 42400

    Office

    $122.74

    Facility

    $56.81

    $22.64 higher than Merced for the office setting.

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

    California · 42400

    Office

    $122.65

    Facility

    $56.72

    $22.55 higher than Merced for the office setting.

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

    California · 42400

    Office

    $125.46

    Facility

    $58.03

    $25.36 higher than Merced for the office setting.

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

    California · 42400

    Office

    $125.08

    Facility

    $57.65

    $24.98 higher than Merced for the office setting.

  • San Luis Obispo-Paso Robles

    California · 42400

    Office

    $102.96

    Facility

    $49.69

    $2.86 higher than Merced for the office setting.

  • Santa Cruz-Watsonville

    California · 42400

    Office

    $108.11

    Facility

    $51.29

    $8.01 higher than Merced for the office setting.

  • Santa Maria-Santa Barbara

    California · 42400

    Office

    $105.03

    Facility

    $50.51

    $4.93 higher than Merced for the office setting.

  • Santa Rosa-Petaluma

    California · 42400

    Office

    $109.20

    Facility

    $51.78

    $9.10 higher than Merced for the office setting.

  • Stockton

    California · 42400

    Office

    $100.10

    Facility

    $48.85

    The same base rate than Merced for the office setting.

  • Vallejo

    California · 42400

    Office

    $115.81

    Facility

    $54.18

    $15.71 higher than Merced for the office setting.

  • Visalia

    California · 42400

    Office

    $100.10

    Facility

    $48.85

    The same base rate than Merced for the office setting.

  • Yuba City

    California · 42400

    Office

    $100.10

    Facility

    $48.85

    The same base rate than Merced for the office setting.

  • Dc + Md/Va Suburbs

    District of Columbia · 42400

    Office

    $108.03

    Facility

    $52.94

    $7.93 higher than Merced for the office setting.

  • Miami

    Florida · 42400

    Office

    $101.34

    Facility

    $52.66

    $1.24 higher than Merced for the office setting.

  • Chicago

    Illinois · 42400

    Office

    $98.49

    Facility

    $51.50

    $1.61 lower than Merced for the office setting.

  • Manhattan

    New York · 42400

    Office

    $108.48

    Facility

    $54.15

    $8.38 higher than Merced for the office setting.

  • Alaska*

    Alaska · 42400

    Office

    $110.34

    Facility

    $60.54

    $10.24 higher than Merced for the office setting.

  • Alabama

    Alabama · 42400

    Office

    $85.06

    Facility

    $44.14

    $15.04 lower than Merced for the office setting.

  • Arkansas

    Arkansas · 42400

    Office

    $83.86

    Facility

    $43.69

    $16.24 lower than Merced for the office setting.

  • Arizona

    Arizona · 42400

    Office

    $92.08

    Facility

    $46.77

    $8.02 lower than Merced for the office setting.

  • Colorado

    Colorado · 42400

    Office

    $98.50

    Facility

    $48.74

    $1.60 lower than Merced for the office setting.

  • Connecticut

    Connecticut · 42400

    Office

    $100.71

    Facility

    $50.35

    $0.61 higher than Merced for the office setting.

  • Delaware

    Delaware · 42400

    Office

    $93.58

    Facility

    $47.38

    $6.52 lower than Merced for the office setting.

  • Fort Lauderdale

    Florida · 42400

    Office

    $97.55

    Facility

    $50.18

    $2.55 lower than Merced for the office setting.

  • Rest Of Florida

    Florida · 42400

    Office

    $92.94

    Facility

    $48.24

    $7.16 lower than Merced for the office setting.

  • Atlanta

    Georgia · 42400

    Office

    $96.20

    Facility

    $48.69

    $3.90 lower than Merced for the office setting.

  • Rest Of Georgia

    Georgia · 42400

    Office

    $87.86

    Facility

    $46.15

    $12.24 lower than Merced for the office setting.

  • Hawaii, Guam

    Hawaii · 42400

    Office

    $102.51

    Facility

    $49.34

    $2.41 higher than Merced for the office setting.

  • Iowa

    Iowa · 42400

    Office

    $87.26

    Facility

    $44.48

    $12.84 lower than Merced for the office setting.

  • Idaho

    Idaho · 42400

    Office

    $87.80

    Facility

    $44.78

    $12.30 lower than Merced for the office setting.

  • East St. Louis

    Illinois · 42400

    Office

    $91.92

    Facility

    $48.90

    $8.18 lower than Merced for the office setting.

  • Rest Of Illinois

    Illinois · 42400

    Office

    $90.25

    Facility

    $47.55

    $9.85 lower than Merced for the office setting.

  • Suburban Chicago

    Illinois · 42400

    Office

    $98.56

    Facility

    $50.54

    $1.54 lower than Merced for the office setting.

  • Indiana

    Indiana · 42400

    Office

    $88.30

    Facility

    $44.95

    $11.80 lower than Merced for the office setting.

  • Kansas

    Kansas · 42400

    Office

    $86.82

    Facility

    $44.55

    $13.28 lower than Merced for the office setting.

  • Kentucky

    Kentucky · 42400

    Office

    $86.92

    Facility

    $45.35

    $13.18 lower than Merced for the office setting.

  • New Orleans

    Louisiana · 42400

    Office

    $90.97

    Facility

    $46.96

    $9.13 lower than Merced for the office setting.

  • Rest Of Louisiana

    Louisiana · 42400

    Office

    $86.77

    Facility

    $45.38

    $13.33 lower than Merced for the office setting.

  • Metropolitan Boston

    Massachusetts · 42400

    Office

    $108.17

    Facility

    $52.33

    $8.07 higher than Merced for the office setting.

  • Rest Of Massachusetts

    Massachusetts · 42400

    Office

    $97.91

    Facility

    $48.67

    $2.19 lower than Merced for the office setting.

  • Baltimore/Surr. Cntys

    Maryland · 42400

    Office

    $100.42

    Facility

    $50.24

    $0.32 higher than Merced for the office setting.

  • Rest Of Maryland

    Maryland · 42400

    Office

    $95.36

    Facility

    $48.03

    $4.74 lower than Merced for the office setting.

  • Rest Of Maine

    Maine · 42400

    Office

    $88.20

    Facility

    $45.18

    $11.90 lower than Merced for the office setting.

  • Southern Maine

    Maine · 42400

    Office

    $92.94

    Facility

    $46.60

    $7.16 lower than Merced for the office setting.

  • Detroit

    Michigan · 42400

    Office

    $94.03

    Facility

    $48.91

    $6.07 lower than Merced for the office setting.

  • Rest Of Michigan

    Michigan · 42400

    Office

    $89.09

    Facility

    $46.39

    $11.01 lower than Merced for the office setting.

  • Minnesota

    Minnesota · 42400

    Office

    $94.57

    Facility

    $46.45

    $5.53 lower than Merced for the office setting.

  • Metropolitan Kansas City

    Missouri · 42400

    Office

    $90.41

    Facility

    $46.50

    $9.69 lower than Merced for the office setting.

  • Metropolitan St. Louis

    Missouri · 42400

    Office

    $91.34

    Facility

    $46.82

    $8.76 lower than Merced for the office setting.

  • Rest Of Missouri

    Missouri · 42400

    Office

    $85.28

    Facility

    $44.97

    $14.82 lower than Merced for the office setting.

  • Mississippi

    Mississippi · 42400

    Office

    $84.59

    Facility

    $44.33

    $15.51 lower than Merced for the office setting.

  • Montana**

    Montana · 42400

    Office

    $94.52

    Facility

    $47.76

    $5.58 lower than Merced for the office setting.

  • North Carolina

    North Carolina · 42400

    Office

    $89.11

    Facility

    $45.48

    $10.99 lower than Merced for the office setting.

  • North Dakota**

    North Dakota · 42400

    Office

    $92.94

    Facility

    $46.18

    $7.16 lower than Merced for the office setting.

  • Nebraska

    Nebraska · 42400

    Office

    $87.74

    Facility

    $44.58

    $12.36 lower than Merced for the office setting.

  • New Hampshire

    New Hampshire · 42400

    Office

    $96.92

    Facility

    $48.24

    $3.18 lower than Merced for the office setting.

  • Northern Nj

    New Jersey · 42400

    Office

    $106.94

    Facility

    $52.70

    $6.84 higher than Merced for the office setting.

  • Rest Of New Jersey

    New Jersey · 42400

    Office

    $101.91

    Facility

    $50.85

    $1.81 higher than Merced for the office setting.

  • New Mexico

    New Mexico · 42400

    Office

    $89.54

    Facility

    $46.66

    $10.56 lower than Merced for the office setting.

  • Nevada**

    Nevada · 42400

    Office

    $94.14

    Facility

    $47.34

    $5.96 lower than Merced for the office setting.

  • Nyc Suburbs/Long Island

    New York · 42400

    Office

    $111.00

    Facility

    $55.40

    $10.90 higher than Merced for the office setting.

  • Poughkpsie/N Nyc Suburbs

    New York · 42400

    Office

    $102.54

    Facility

    $51.34

    $2.44 higher than Merced for the office setting.

  • Queens

    New York · 42400

    Office

    $109.43

    Facility

    $54.16

    $9.33 higher than Merced for the office setting.

  • Rest Of New York

    New York · 42400

    Office

    $90.41

    Facility

    $45.98

    $9.69 lower than Merced for the office setting.

  • Ohio

    Ohio · 42400

    Office

    $88.76

    Facility

    $46.07

    $11.34 lower than Merced for the office setting.

  • Oklahoma

    Oklahoma · 42400

    Office

    $86.82

    Facility

    $45.06

    $13.28 lower than Merced for the office setting.

  • Portland

    Oregon · 42400

    Office

    $101.62

    Facility

    $49.67

    $1.52 higher than Merced for the office setting.

  • Rest Of Oregon

    Oregon · 42400

    Office

    $93.47

    Facility

    $46.89

    $6.63 lower than Merced for the office setting.

  • Metropolitan Philadelphia

    Pennsylvania · 42400

    Office

    $98.22

    Facility

    $49.54

    $1.88 lower than Merced for the office setting.

  • Rest Of Pennsylvania

    Pennsylvania · 42400

    Office

    $88.93

    Facility

    $46.00

    $11.17 lower than Merced for the office setting.

  • Puerto Rico

    Puerto Rico · 42400

    Office

    $95.22

    Facility

    $47.94

    $4.88 lower than Merced for the office setting.

  • Rhode Island

    Rhode Island · 42400

    Office

    $96.91

    Facility

    $48.61

    $3.19 lower than Merced for the office setting.

  • South Carolina

    South Carolina · 42400

    Office

    $89.07

    Facility

    $45.86

    $11.03 lower than Merced for the office setting.

  • South Dakota**

    South Dakota · 42400

    Office

    $92.75

    Facility

    $45.99

    $7.35 lower than Merced for the office setting.

  • Tennessee

    Tennessee · 42400

    Office

    $87.24

    Facility

    $44.73

    $12.86 lower than Merced for the office setting.

  • Austin

    Texas · 42400

    Office

    $98.13

    Facility

    $48.65

    $1.97 lower than Merced for the office setting.

  • Beaumont

    Texas · 42400

    Office

    $88.35

    Facility

    $45.80

    $11.75 lower than Merced for the office setting.

  • Brazoria

    Texas · 42400

    Office

    $93.54

    Facility

    $47.20

    $6.56 lower than Merced for the office setting.

  • Dallas

    Texas · 42400

    Office

    $94.11

    Facility

    $47.53

    $5.99 lower than Merced for the office setting.

  • Fort Worth

    Texas · 42400

    Office

    $93.48

    Facility

    $47.37

    $6.62 lower than Merced for the office setting.

  • Galveston

    Texas · 42400

    Office

    $93.80

    Facility

    $47.37

    $6.30 lower than Merced for the office setting.

  • Houston

    Texas · 42400

    Office

    $95.27

    Facility

    $48.83

    $4.83 lower than Merced for the office setting.

  • Rest Of Texas

    Texas · 42400

    Office

    $90.88

    Facility

    $46.50

    $9.22 lower than Merced for the office setting.

  • Utah

    Utah · 42400

    Office

    $90.26

    Facility

    $46.31

    $9.84 lower than Merced for the office setting.

  • Virginia

    Virginia · 42400

    Office

    $92.61

    Facility

    $46.64

    $7.49 lower than Merced for the office setting.

  • Virgin Islands

    United States Virgin Islands · 42400

    Office

    $95.22

    Facility

    $47.94

    $4.88 lower than Merced for the office setting.

  • Vermont

    Vermont · 42400

    Office

    $92.54

    Facility

    $46.25

    $7.56 lower than Merced for the office setting.

  • Rest Of Washington

    Washington · 42400

    Office

    $97.74

    Facility

    $48.50

    $2.36 lower than Merced for the office setting.

  • Seattle (King Cnty)

    Washington · 42400

    Office

    $110.39

    Facility

    $53.02

    $10.29 higher than Merced for the office setting.

  • Wisconsin

    Wisconsin · 42400

    Office

    $89.88

    Facility

    $45.09

    $10.22 lower than Merced for the office setting.

  • West Virginia

    West Virginia · 42400

    Office

    $86.97

    Facility

    $46.33

    $13.13 lower than Merced for the office setting.

  • Wyoming**

    Wyoming · 42400

    Office

    $93.83

    Facility

    $47.07

    $6.27 lower than Merced for the office setting.

See how rates vary across the country

42400 · 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.

$83.86

$112.78

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

View all state and territory rates as a table
State / territoryRate rangeLocalities
AK$110.341
AL$85.061
AR$83.861
AZ$92.081
CA$100.10–$125.4629
CO$98.501
CT$100.711
DC$108.031
DE$93.581
FL$92.94–$101.343
GA$87.86–$96.202
GU$102.511
HI$102.511
IA$87.261
ID$87.801
IL$90.25–$98.564
IN$88.301
KS$86.821
KY$86.921
LA$86.77–$90.972
MA$97.91–$108.172
MD$95.36–$108.033
ME$88.20–$92.942
MI$89.09–$94.032
MN$94.571
MO$85.28–$91.343
MS$84.591
MT$94.521
NC$89.111
ND$92.941
NE$87.741
NH$96.921
NJ$101.91–$106.942
NM$89.541
NV$94.141
NY$90.41–$111.005
OH$88.761
OK$86.821
OR$93.47–$101.622
PA$88.93–$98.222
PR$95.221
RI$96.911
SC$89.071
SD$92.751
TN$87.241
TX$88.35–$98.138
UT$90.261
VA$92.61–$108.032
VI$95.221
VT$92.541
WA$97.74–$110.392
WI$89.881
WV$86.971
WY$93.831

Explore 42400 on the national rate map →

Where does this rate apply?

Merced is a Medicare payment area. Our Census mapping connects it to 24 cities and communities in California, 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 California →

Why are the office and facility amounts different?

For 42400 in Merced, the physician’s office rate is $100.10 and the facility-setting rate is $48.85: a difference of $51.25.

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 42400 in Merced. This uses the base rate on this page, so the locality and release stay consistent.

Reference amount per service

$110.11

$100.10 × 110% = $110.11

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 42400 in Merced.

PPRRVU2026_Oct_nonQPP.csv

5,027

Code
42400
Physician work
0.76
Practice expense
1.99
Malpractice
0.08

GPCI2026.csv

15

Locality
Merced
Physician work
1.017
Practice expense
1.096
Malpractice
0.536
Office / nonfacility calculation for 42400 in Merced
ComponentRVULocality factorAdjusted
Physician work0.76× 1.0170.7729
Practice expense1.99× 1.0962.1810
Malpractice0.08× 0.5360.0429
Total RVUs2.9968
Conversion factor× 33.4009

Office / nonfacility rate, Merced$100.10

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

Open 42400 in the RVU calculator →

Explore RVUs, geographic factors and the full formula

Office / nonfacility

Office / nonfacility calculation inputs
ComponentRVULocal GPCI
Work0.761.017
Practice expense1.991.096
Malpractice0.080.536

(0.76 × 1.017 + 1.99 × 1.096 + 0.08 × 0.536) × $33.4009 = $100.10

Facility

Facility calculation inputs
ComponentRVULocal GPCI
Work0.761.017
Practice expense0.591.096
Malpractice0.080.536

(0.76 × 1.017 + 0.59 × 1.096 + 0.08 × 0.536) × $33.4009 = $48.85

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

42400 · Office / nonfacility

$100.10

Effective 2026-10-01

The base rate is $3.60 higher than on 2025-10-01, moving from $96.50 to $100.10 (3.7%).

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

    $96.50changed to$100.10

    • Conversion factor 32.3465 changed to 33.4009
    • Work RVU 0.78 changed to 0.76
    • Practice expense RVU 1.97 changed to 1.99
    • Malpractice RVU 0.07 changed to 0.08
    • Work GPCI 1.014 changed to 1.017
    • Practice expense GPCI 1.093 changed to 1.096
    • Malpractice GPCI 0.560 changed to 0.536

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    Earliest loaded release: $96.50

    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$100.10$48.85RVU26D
2026-07-01$100.10$48.85RVU26C
2026-04-01$100.10$48.85RVU26B
2026-01-01$100.10$48.85RVU26A
2025-10-01$96.50$53.01RVU25D
2025-07-01$96.50$53.01RVU25C
2025-04-01$96.50$53.01RVU25B
2025-01-01$96.50$53.01RVU25A

42400 billing questions

How does this differ from an incisional salivary gland biopsy?

42400 is for needle-based tissue sampling. Use 42405 when the physician obtains the biopsy through an incision.

Can this be reported for fine-needle aspiration?

Fine-needle aspiration services use the aspiration biopsy code set, such as 10021 without imaging guidance or 10005 with ultrasound guidance. Do not select 42400 solely because the target is a salivary gland.

Is same-day postoperative care included?

Yes. The 0-day global period includes same-day preoperative and postoperative care.

Can modifier 50 be used for biopsies on both sides?

No. The CMS bilateral adjustment does not apply to 42400, and modifier 50 is inappropriate.

How are other procedures in the same session paid?

The highest-valued procedure is paid in full, with the standard multiple-procedure reduction applied to the other procedures. Medicare does not pay an assistant at surgery for 42400; co-surgeons and team surgery are 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 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 42400PPRRVU2026_Oct_nonQPP.csv, line 5,027 (RVU26D)
Geographic factors for MercedGPCI2026.csv, line 15 (RVU26D)
Open CMS sourceHow this rate is calculatedBuild a fee sheet