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CMS RVU26D · Effective 2026-10-01

42320 in Modesto

Office / nonfacility

$273.91

Base rate per service

Facility setting

$164.82

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 42320: Extraoral submandibular abscess drainage

Reports surgical drainage of an abscess involving the submandibular salivary gland when the surgeon uses an external approach through the neck.

This service involves reaching an abscess associated with the submandibular salivary gland through an incision outside the mouth, then opening and draining the collection. Otolaryngologists and oral and maxillofacial surgeons commonly perform it for a suppurative submandibular gland infection or related collection requiring external access, typically in a surgical setting.

Choose this code when the operative note identifies the submandibular gland and documents the external approach and drainage of an abscess. The intraoral approach is reported with 42310; removal of a salivary stone is a different service. Related postoperative visits during the 10-day global period are included. When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and others at 50%. Modifier 50 is inappropriate for this service. Assistant-at-surgery payment requires documented medical necessity; co-surgeons and team surgery are not permitted.

CMS billing rules for 42320

Global period
Minor procedure with a 10-day global period: related postoperative visits for 10 days 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 RVU2.34 · 30%
  • Practice expense (office) RVU5.14 · 66%
  • Malpractice RVU0.35 · 4%

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.

42320 compared with similar codes

Office rates for Modesto, from the same CMS release.

42310

Salivary drainage

Intraoral approach

$192.35

Both codes describe drainage of a submandibular abscess. Select 42320 for an external approach and 42310 for an intraoral approach.

42300

Abscess drainage

Superficial salivary gland

$225.06

This code is for simple parotid abscess drainage, rather than drainage involving the submandibular gland.

42305

Salivary drainage

Extraoral abscess

No office rate

This code is for complicated parotid abscess drainage. The gland and documented procedure, not just the abscess, distinguish it from 42320.

42330

Salivary stone removal

Intraoral submandibular or sublingual

$248.67

42330 describes removal of a salivary stone; 42320 describes drainage of a submandibular abscess through an external approach.

The same code, a different location

How does Modesto compare?

In Bakersfield, the office rate for 42320 is $274.92—$1.01 higher than the $273.91 rate in Modesto. Both use the same code, release and participation basis.

42320 across payment areas

Same release and payment basis · bars start at $0

  1. Modesto · This locality

    $273.91

  2. Bakersfield

    $274.92

    $1.01 higher than Modesto

  3. Chico

    $273.91

    The same base rate than Modesto

  4. El Centro

    $273.97

    $0.06 higher than Modesto

  5. Fresno

    $273.91

    The same base rate than Modesto

  6. Hanford-Corcoran

    $273.91

    The same base rate than Modesto

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

    $292.22

    $18.31 higher than Modesto

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, 42320 ranges from $231.65 in Arkansas to $340.58 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 · 42320

    Office

    $273.91

    Facility

    $164.82

    The same base rate than Modesto for the office setting.

  • Merced

    California · 42320

    Office

    $273.91

    Facility

    $164.82

    The same base rate than Modesto for the office setting.

  • Napa

    California · 42320

    Office

    $315.30

    Facility

    $184.11

    $41.39 higher than Modesto for the office setting.

  • Oxnard-Thousand Oaks-Ventura

    California · 42320

    Office

    $290.56

    Facility

    $172.91

    $16.65 higher than Modesto for the office setting.

  • Redding

    California · 42320

    Office

    $273.91

    Facility

    $164.82

    The same base rate than Modesto for the office setting.

  • Rest Of California

    California · 42320

    Office

    $273.91

    Facility

    $164.82

    The same base rate than Modesto for the office setting.

  • Riverside-San Bernardino-Ontario

    California · 42320

    Office

    $277.70

    Facility

    $168.61

    $3.79 higher than Modesto for the office setting.

  • Sacramento-Roseville-Folsom

    California · 42320

    Office

    $286.90

    Facility

    $171.14

    $12.99 higher than Modesto for the office setting.

  • Salinas

    California · 42320

    Office

    $285.82

    Facility

    $170.46

    $11.91 higher than Modesto for the office setting.

  • San Diego-Chula Vista-Carlsbad

    California · 42320

    Office

    $292.17

    Facility

    $173.13

    $18.26 higher than Modesto for the office setting.

  • San Francisco-Oakland-Berkeley (Marin Cnty)

    California · 42320

    Office

    $333.02

    Facility

    $192.67

    $59.11 higher than Modesto for the office setting.

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

    California · 42320

    Office

    $332.62

    Facility

    $192.28

    $58.71 higher than Modesto for the office setting.

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

    California · 42320

    Office

    $340.58

    Facility

    $197.06

    $66.67 higher than Modesto for the office setting.

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

    California · 42320

    Office

    $338.96

    Facility

    $195.43

    $65.05 higher than Modesto for the office setting.

  • San Luis Obispo-Paso Robles

    California · 42320

    Office

    $281.30

    Facility

    $167.93

    $7.39 higher than Modesto for the office setting.

  • Santa Cruz-Watsonville

    California · 42320

    Office

    $294.66

    Facility

    $173.72

    $20.75 higher than Modesto for the office setting.

  • Santa Maria-Santa Barbara

    California · 42320

    Office

    $286.79

    Facility

    $170.73

    $12.88 higher than Modesto for the office setting.

  • Santa Rosa-Petaluma

    California · 42320

    Office

    $297.59

    Facility

    $175.36

    $23.68 higher than Modesto for the office setting.

  • Stockton

    California · 42320

    Office

    $273.91

    Facility

    $164.82

    The same base rate than Modesto for the office setting.

  • Vallejo

    California · 42320

    Office

    $314.72

    Facility

    $183.54

    $40.81 higher than Modesto for the office setting.

  • Visalia

    California · 42320

    Office

    $273.91

    Facility

    $164.82

    The same base rate than Modesto for the office setting.

  • Yuba City

    California · 42320

    Office

    $273.91

    Facility

    $164.82

    The same base rate than Modesto for the office setting.

  • Dc + Md/Va Suburbs

    District of Columbia · 42320

    Office

    $297.63

    Facility

    $180.38

    $23.72 higher than Modesto for the office setting.

  • Miami

    Florida · 42320

    Office

    $286.44

    Facility

    $182.83

    $12.53 higher than Modesto for the office setting.

  • Chicago

    Illinois · 42320

    Office

    $278.07

    Facility

    $178.04

    $4.16 higher than Modesto for the office setting.

  • Manhattan

    New York · 42320

    Office

    $301.19

    Facility

    $185.53

    $27.28 higher than Modesto for the office setting.

  • Alaska*

    Alaska · 42320

    Office

    $306.52

    Facility

    $200.51

    $32.61 higher than Modesto for the office setting.

  • Alabama

    Alabama · 42320

    Office

    $235.00

    Facility

    $147.90

    $38.91 lower than Modesto for the office setting.

  • Arkansas

    Arkansas · 42320

    Office

    $231.65

    Facility

    $146.15

    $42.26 lower than Modesto for the office setting.

  • Arizona

    Arizona · 42320

    Office

    $254.52

    Facility

    $158.07

    $19.39 lower than Modesto for the office setting.

  • Colorado

    Colorado · 42320

    Office

    $270.89

    Facility

    $164.99

    $3.02 lower than Modesto for the office setting.

  • Connecticut

    Connecticut · 42320

    Office

    $278.77

    Facility

    $171.57

    $4.86 higher than Modesto for the office setting.

  • Delaware

    Delaware · 42320

    Office

    $258.68

    Facility

    $160.34

    $15.23 lower than Modesto for the office setting.

  • Fort Lauderdale

    Florida · 42320

    Office

    $273.21

    Facility

    $172.38

    $0.70 lower than Modesto for the office setting.

  • Rest Of Florida

    Florida · 42320

    Office

    $259.86

    Facility

    $164.70

    $14.05 lower than Modesto for the office setting.

  • Atlanta

    Georgia · 42320

    Office

    $266.86

    Facility

    $165.73

    $7.05 lower than Modesto for the office setting.

  • Rest Of Georgia

    Georgia · 42320

    Office

    $245.23

    Facility

    $156.45

    $28.68 lower than Modesto for the office setting.

  • Hawaii, Guam

    Hawaii · 42320

    Office

    $280.13

    Facility

    $166.96

    $6.22 higher than Modesto for the office setting.

  • Iowa

    Iowa · 42320

    Office

    $239.89

    Facility

    $148.81

    $34.02 lower than Modesto for the office setting.

  • Idaho

    Idaho · 42320

    Office

    $241.63

    Facility

    $150.06

    $32.28 lower than Modesto for the office setting.

  • East St. Louis

    Illinois · 42320

    Office

    $259.65

    Facility

    $168.08

    $14.26 lower than Modesto for the office setting.

  • Rest Of Illinois

    Illinois · 42320

    Office

    $253.17

    Facility

    $162.30

    $20.74 lower than Modesto for the office setting.

  • Suburban Chicago

    Illinois · 42320

    Office

    $275.74

    Facility

    $173.51

    $1.83 higher than Modesto for the office setting.

  • Indiana

    Indiana · 42320

    Office

    $242.99

    Facility

    $150.72

    $30.92 lower than Modesto for the office setting.

  • Kansas

    Kansas · 42320

    Office

    $239.25

    Facility

    $149.27

    $34.66 lower than Modesto for the office setting.

  • Kentucky

    Kentucky · 42320

    Office

    $241.48

    Facility

    $152.99

    $32.43 lower than Modesto for the office setting.

  • New Orleans

    Louisiana · 42320

    Office

    $252.99

    Facility

    $159.33

    $20.92 lower than Modesto for the office setting.

  • Rest Of Louisiana

    Louisiana · 42320

    Office

    $241.29

    Facility

    $153.21

    $32.62 lower than Modesto for the office setting.

  • Metropolitan Boston

    Massachusetts · 42320

    Office

    $296.75

    Facility

    $177.91

    $22.84 higher than Modesto for the office setting.

  • Rest Of Massachusetts

    Massachusetts · 42320

    Office

    $269.51

    Facility

    $164.70

    $4.40 lower than Modesto for the office setting.

  • Baltimore/Surr. Cntys

    Maryland · 42320

    Office

    $278.08

    Facility

    $171.28

    $4.17 higher than Modesto for the office setting.

  • Rest Of Maryland

    Maryland · 42320

    Office

    $263.41

    Facility

    $162.68

    $10.50 lower than Modesto for the office setting.

  • Rest Of Maine

    Maine · 42320

    Office

    $243.38

    Facility

    $151.80

    $30.53 lower than Modesto for the office setting.

  • Southern Maine

    Maine · 42320

    Office

    $255.67

    Facility

    $157.03

    $18.24 lower than Modesto for the office setting.

  • Detroit

    Michigan · 42320

    Office

    $263.54

    Facility

    $167.49

    $10.37 lower than Modesto for the office setting.

  • Rest Of Michigan

    Michigan · 42320

    Office

    $248.10

    Facility

    $157.23

    $25.81 lower than Modesto for the office setting.

  • Minnesota

    Minnesota · 42320

    Office

    $258.28

    Facility

    $155.86

    $15.63 lower than Modesto for the office setting.

  • Metropolitan Kansas City

    Missouri · 42320

    Office

    $250.79

    Facility

    $157.32

    $23.12 lower than Modesto for the office setting.

  • Metropolitan St. Louis

    Missouri · 42320

    Office

    $253.31

    Facility

    $158.55

    $20.60 lower than Modesto for the office setting.

  • Rest Of Missouri

    Missouri · 42320

    Office

    $237.53

    Facility

    $151.73

    $36.38 lower than Modesto for the office setting.

  • Mississippi

    Mississippi · 42320

    Office

    $234.61

    Facility

    $148.91

    $39.30 lower than Modesto for the office setting.

  • Montana**

    Montana · 42320

    Office

    $261.51

    Facility

    $161.97

    $12.40 lower than Modesto for the office setting.

  • North Carolina

    North Carolina · 42320

    Office

    $245.81

    Facility

    $152.94

    $28.10 lower than Modesto for the office setting.

  • North Dakota**

    North Dakota · 42320

    Office

    $254.58

    Facility

    $155.05

    $19.33 lower than Modesto for the office setting.

  • Nebraska

    Nebraska · 42320

    Office

    $241.04

    Facility

    $149.17

    $32.87 lower than Modesto for the office setting.

  • New Hampshire

    New Hampshire · 42320

    Office

    $267.11

    Facility

    $163.49

    $6.80 lower than Modesto for the office setting.

  • Northern Nj

    New Jersey · 42320

    Office

    $294.72

    Facility

    $179.26

    $20.81 higher than Modesto for the office setting.

  • Rest Of New Jersey

    New Jersey · 42320

    Office

    $281.58

    Facility

    $172.89

    $7.67 higher than Modesto for the office setting.

  • New Mexico

    New Mexico · 42320

    Office

    $249.63

    Facility

    $158.36

    $24.28 lower than Modesto for the office setting.

  • Nevada**

    Nevada · 42320

    Office

    $259.75

    Facility

    $160.11

    $14.16 lower than Modesto for the office setting.

  • Nyc Suburbs/Long Island

    New York · 42320

    Office

    $309.00

    Facility

    $190.65

    $35.09 higher than Modesto for the office setting.

  • Poughkpsie/N Nyc Suburbs

    New York · 42320

    Office

    $283.81

    Facility

    $174.82

    $9.90 higher than Modesto for the office setting.

  • Queens

    New York · 42320

    Office

    $302.94

    Facility

    $185.29

    $29.03 higher than Modesto for the office setting.

  • Rest Of New York

    New York · 42320

    Office

    $249.47

    Facility

    $154.92

    $24.44 lower than Modesto for the office setting.

  • Ohio

    Ohio · 42320

    Office

    $246.69

    Facility

    $155.81

    $27.22 lower than Modesto for the office setting.

  • Oklahoma

    Oklahoma · 42320

    Office

    $240.55

    Facility

    $151.67

    $33.36 lower than Modesto for the office setting.

  • Portland

    Oregon · 42320

    Office

    $278.84

    Facility

    $168.26

    $4.93 higher than Modesto for the office setting.

  • Rest Of Oregon

    Oregon · 42320

    Office

    $257.37

    Facility

    $158.23

    $16.54 lower than Modesto for the office setting.

  • Metropolitan Philadelphia

    Pennsylvania · 42320

    Office

    $272.23

    Facility

    $168.62

    $1.68 lower than Modesto for the office setting.

  • Rest Of Pennsylvania

    Pennsylvania · 42320

    Office

    $246.81

    Facility

    $155.44

    $27.10 lower than Modesto for the office setting.

  • Puerto Rico

    Puerto Rico · 42320

    Office

    $263.24

    Facility

    $162.61

    $10.67 lower than Modesto for the office setting.

  • Rhode Island

    Rhode Island · 42320

    Office

    $267.42

    Facility

    $164.60

    $6.49 lower than Modesto for the office setting.

  • South Carolina

    South Carolina · 42320

    Office

    $246.73

    Facility

    $154.76

    $27.18 lower than Modesto for the office setting.

  • South Dakota**

    South Dakota · 42320

    Office

    $253.77

    Facility

    $154.23

    $20.14 lower than Modesto for the office setting.

  • Tennessee

    Tennessee · 42320

    Office

    $240.49

    Facility

    $150.02

    $33.42 lower than Modesto for the office setting.

  • Austin

    Texas · 42320

    Office

    $270.31

    Facility

    $165.00

    $3.60 lower than Modesto for the office setting.

  • Beaumont

    Texas · 42320

    Office

    $245.25

    Facility

    $154.67

    $28.66 lower than Modesto for the office setting.

  • Brazoria

    Texas · 42320

    Office

    $258.04

    Facility

    $159.40

    $15.87 lower than Modesto for the office setting.

  • Dallas

    Texas · 42320

    Office

    $259.89

    Facility

    $160.75

    $14.02 lower than Modesto for the office setting.

  • Fort Worth

    Texas · 42320

    Office

    $258.32

    Facility

    $160.18

    $15.59 lower than Modesto for the office setting.

  • Galveston

    Texas · 42320

    Office

    $258.94

    Facility

    $160.10

    $14.97 lower than Modesto for the office setting.

  • Houston

    Texas · 42320

    Office

    $265.35

    Facility

    $166.51

    $8.56 lower than Modesto for the office setting.

  • Rest Of Texas

    Texas · 42320

    Office

    $251.64

    Facility

    $157.18

    $22.27 lower than Modesto for the office setting.

  • Utah

    Utah · 42320

    Office

    $250.04

    Facility

    $156.47

    $23.87 lower than Modesto for the office setting.

  • Virginia

    Virginia · 42320

    Office

    $255.17

    Facility

    $157.33

    $18.74 lower than Modesto for the office setting.

  • Virgin Islands

    United States Virgin Islands · 42320

    Office

    $263.24

    Facility

    $162.61

    $10.67 lower than Modesto for the office setting.

  • Vermont

    Vermont · 42320

    Office

    $254.04

    Facility

    $155.50

    $19.87 lower than Modesto for the office setting.

  • Rest Of Washington

    Washington · 42320

    Office

    $268.85

    Facility

    $164.04

    $5.06 lower than Modesto for the office setting.

  • Seattle (King Cnty)

    Washington · 42320

    Office

    $302.27

    Facility

    $180.14

    $28.36 higher than Modesto for the office setting.

  • Wisconsin

    Wisconsin · 42320

    Office

    $246.23

    Facility

    $150.87

    $27.68 lower than Modesto for the office setting.

  • West Virginia

    West Virginia · 42320

    Office

    $244.08

    Facility

    $157.58

    $29.83 lower than Modesto for the office setting.

  • Wyoming**

    Wyoming · 42320

    Office

    $258.49

    Facility

    $158.95

    $15.42 lower than Modesto for the office setting.

See how rates vary across the country

42320 · 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.

$231.65

$307.25

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

View all state and territory rates as a table
State / territoryRate rangeLocalities
AK$306.521
AL$235.001
AR$231.651
AZ$254.521
CA$273.91–$340.5829
CO$270.891
CT$278.771
DC$297.631
DE$258.681
FL$259.86–$286.443
GA$245.23–$266.862
GU$280.131
HI$280.131
IA$239.891
ID$241.631
IL$253.17–$278.074
IN$242.991
KS$239.251
KY$241.481
LA$241.29–$252.992
MA$269.51–$296.752
MD$263.41–$297.633
ME$243.38–$255.672
MI$248.10–$263.542
MN$258.281
MO$237.53–$253.313
MS$234.611
MT$261.511
NC$245.811
ND$254.581
NE$241.041
NH$267.111
NJ$281.58–$294.722
NM$249.631
NV$259.751
NY$249.47–$309.005
OH$246.691
OK$240.551
OR$257.37–$278.842
PA$246.81–$272.232
PR$263.241
RI$267.421
SC$246.731
SD$253.771
TN$240.491
TX$245.25–$270.318
UT$250.041
VA$255.17–$297.632
VI$263.241
VT$254.041
WA$268.85–$302.272
WI$246.231
WV$244.081
WY$258.491

Explore 42320 on the national rate map →

Where does this rate apply?

Modesto is a Medicare payment area. Our Census mapping connects it to 33 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 42320 in Modesto, the physician’s office rate is $273.91 and the facility-setting rate is $164.82: a difference of $109.09.

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 42320 in Modesto. This uses the base rate on this page, so the locality and release stay consistent.

Reference amount per service

$301.30

$273.91 × 110% = $301.30

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 42320 in Modesto.

PPRRVU2026_Oct_nonQPP.csv

5,023

Code
42320
Physician work
2.34
Practice expense
5.14
Malpractice
0.35

GPCI2026.csv

16

Locality
Modesto
Physician work
1.017
Practice expense
1.096
Malpractice
0.536
Office / nonfacility calculation for 42320 in Modesto
ComponentRVULocality factorAdjusted
Physician work2.34× 1.0172.3798
Practice expense5.14× 1.0965.6334
Malpractice0.35× 0.5360.1876
Total RVUs8.2008
Conversion factor× 33.4009

Office / nonfacility rate, Modesto$273.91

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

Open 42320 in the RVU calculator →

Explore RVUs, geographic factors and the full formula

Office / nonfacility

Office / nonfacility calculation inputs
ComponentRVULocal GPCI
Work2.341.017
Practice expense5.141.096
Malpractice0.350.536

(2.34 × 1.017 + 5.14 × 1.096 + 0.35 × 0.536) × $33.4009 = $273.91

Facility

Facility calculation inputs
ComponentRVULocal GPCI
Work2.341.017
Practice expense2.161.096
Malpractice0.350.536

(2.34 × 1.017 + 2.16 × 1.096 + 0.35 × 0.536) × $33.4009 = $164.82

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

42320 · Office / nonfacility

$273.91

Effective 2026-10-01

The base rate is $10.66 higher than on 2025-10-01, moving from $263.25 to $273.91 (4.0%).

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

    $263.25changed to$273.91

    • Conversion factor 32.3465 changed to 33.4009
    • Work RVU 2.40 changed to 2.34
    • Practice expense RVU 5.04 changed to 5.14
    • 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: $263.25

    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$273.91$164.82RVU26D
2026-07-01$273.91$164.82RVU26C
2026-04-01$273.91$164.82RVU26B
2026-01-01$273.91$164.82RVU26A
2025-10-01$263.25$180.52RVU25D
2025-07-01$263.25$180.52RVU25C
2025-04-01$263.25$180.52RVU25B
2025-01-01$263.25$180.52RVU25A

42320 billing questions

How is 42320 distinguished from 42310?

42320 describes drainage through an external approach for a submandibular abscess. Use 42310 when the documented drainage approach is intraoral.

Does this code include removal of a salivary stone?

No. This service is for abscess drainage; stone removal is a separate procedure. Report any additional service only when it was performed and separately reportable.

Can modifier 50 be appended for bilateral treatment?

No. The anatomy or descriptor makes modifier 50 inappropriate for this code.

Are postoperative visits separately reported during the global period?

Related postoperative visits during the 10-day global period are included in the procedure.

When is an assistant at surgery payable?

Assistant-at-surgery payment is available only when the documentation supports medical necessity. 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 42320PPRRVU2026_Oct_nonQPP.csv, line 5,023 (RVU26D)
Geographic factors for ModestoGPCI2026.csv, line 16 (RVU26D)
Open CMS sourceHow this rate is calculatedBuild a fee sheet