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CMS RVU26D · Effective 2026-10-01

42405 in Modesto

Office / nonfacility

$319.22

Base rate per service

Facility setting

$204.27

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.

Head and neck surgery

About 42405: Incisional salivary gland biopsy

Report this service when a surgeon obtains salivary gland tissue through an incision for diagnostic evaluation rather than sampling it with a needle.

This code describes an incisional biopsy that obtains salivary gland tissue for diagnosis. An otolaryngologist, head and neck surgeon, or oral and maxillofacial surgeon may perform it when a gland abnormality needs tissue evaluation, such as a persistent mass or unexplained enlargement. The surgeon exposes the selected gland tissue and removes a sample; the procedure may take place in an office or a facility, depending on the clinical situation and operative approach.

Choose this code for incisional tissue sampling, not needle sampling or definitive removal of a gland or lesion. The note should identify the gland and side, the reason for biopsy, the incisional approach, and the tissue obtained. Histologic examination is a separate service when performed and separately reportable. The code has a 10-day global period, so related postoperative visits during that period are included. When other procedures are performed 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 is restricted; co-surgeons and team surgery are not permitted.

CMS billing rules for 42405

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
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 RVU3.26 · 35%
  • Practice expense (office) RVU5.47 · 60%
  • Malpractice RVU0.46 · 5%

937

Medicare services in 2024 · #3019 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.

42405 compared with similar codes

Office rates for Modesto, from the same CMS release.

42400

Salivary biopsy

Needle tissue sampling

$100.10

Use 42405 for an incisional sample and 42400 when the salivary gland tissue is obtained by needle.

42410

Parotid excision

Lateral lobe, no nerve dissection

No office rate

42405 obtains tissue for diagnosis; 42410 describes excision of a parotid gland or lesion.

42440

Salivary gland excision

Submandibular gland

No office rate

42405 samples gland tissue; 42440 is for excision of the submaxillary gland.

The same code, a different location

How does Modesto compare?

In Bakersfield, the office rate for 42405 is $320.56—$1.34 higher than the $319.22 rate in Modesto. Both use the same code, release and participation basis.

42405 across payment areas

Same release and payment basis · bars start at $0

  1. Modesto · This locality

    $319.22

  2. Bakersfield

    $320.56

    $1.34 higher than Modesto

  3. Chico

    $319.22

    The same base rate than Modesto

  4. El Centro

    $319.29

    $0.07 higher than Modesto

  5. Fresno

    $319.22

    The same base rate than Modesto

  6. Hanford-Corcoran

    $319.22

    The same base rate than Modesto

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

    $339.69

    $20.47 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, 42405 ranges from $273.74 in Arkansas to $392.56 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 · 42405

    Office

    $319.22

    Facility

    $204.27

    The same base rate than Modesto for the office setting.

  • Merced

    California · 42405

    Office

    $319.22

    Facility

    $204.27

    The same base rate than Modesto for the office setting.

  • Napa

    California · 42405

    Office

    $364.35

    Facility

    $226.12

    $45.13 higher than Modesto for the office setting.

  • Oxnard-Thousand Oaks-Ventura

    California · 42405

    Office

    $337.46

    Facility

    $213.50

    $18.24 higher than Modesto for the office setting.

  • Redding

    California · 42405

    Office

    $319.22

    Facility

    $204.27

    The same base rate than Modesto for the office setting.

  • Rest Of California

    California · 42405

    Office

    $319.22

    Facility

    $204.27

    The same base rate than Modesto for the office setting.

  • Riverside-San Bernardino-Ontario

    California · 42405

    Office

    $324.20

    Facility

    $209.25

    $4.98 higher than Modesto for the office setting.

  • Sacramento-Roseville-Folsom

    California · 42405

    Office

    $333.53

    Facility

    $211.55

    $14.31 higher than Modesto for the office setting.

  • Salinas

    California · 42405

    Office

    $332.25

    Facility

    $210.70

    $13.03 higher than Modesto for the office setting.

  • San Diego-Chula Vista-Carlsbad

    California · 42405

    Office

    $338.99

    Facility

    $213.56

    $19.77 higher than Modesto for the office setting.

  • San Francisco-Oakland-Berkeley (Marin Cnty)

    California · 42405

    Office

    $383.89

    Facility

    $236.02

    $64.67 higher than Modesto for the office setting.

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

    California · 42405

    Office

    $383.37

    Facility

    $235.49

    $64.15 higher than Modesto for the office setting.

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

    California · 42405

    Office

    $392.56

    Facility

    $241.32

    $73.34 higher than Modesto for the office setting.

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

    California · 42405

    Office

    $390.42

    Facility

    $239.19

    $71.20 higher than Modesto for the office setting.

  • San Luis Obispo-Paso Robles

    California · 42405

    Office

    $327.07

    Facility

    $207.61

    $7.85 higher than Modesto for the office setting.

  • Santa Cruz-Watsonville

    California · 42405

    Office

    $341.39

    Facility

    $213.97

    $22.17 higher than Modesto for the office setting.

  • Santa Maria-Santa Barbara

    California · 42405

    Office

    $333.20

    Facility

    $210.91

    $13.98 higher than Modesto for the office setting.

  • Santa Rosa-Petaluma

    California · 42405

    Office

    $344.75

    Facility

    $215.96

    $25.53 higher than Modesto for the office setting.

  • Stockton

    California · 42405

    Office

    $319.22

    Facility

    $204.27

    The same base rate than Modesto for the office setting.

  • Vallejo

    California · 42405

    Office

    $363.60

    Facility

    $225.37

    $44.38 higher than Modesto for the office setting.

  • Visalia

    California · 42405

    Office

    $319.22

    Facility

    $204.27

    The same base rate than Modesto for the office setting.

  • Yuba City

    California · 42405

    Office

    $319.22

    Facility

    $204.27

    The same base rate than Modesto for the office setting.

  • Dc + Md/Va Suburbs

    District of Columbia · 42405

    Office

    $347.09

    Facility

    $223.54

    $27.87 higher than Modesto for the office setting.

  • Miami

    Florida · 42405

    Office

    $337.94

    Facility

    $228.76

    $18.72 higher than Modesto for the office setting.

  • Chicago

    Illinois · 42405

    Office

    $328.53

    Facility

    $223.12

    $9.31 higher than Modesto for the office setting.

  • Manhattan

    New York · 42405

    Office

    $352.52

    Facility

    $230.66

    $33.30 higher than Modesto for the office setting.

  • Alaska*

    Alaska · 42405

    Office

    $366.37

    Facility

    $254.68

    $47.15 higher than Modesto for the office setting.

  • Alabama

    Alabama · 42405

    Office

    $277.45

    Facility

    $185.68

    $41.77 lower than Modesto for the office setting.

  • Arkansas

    Arkansas · 42405

    Office

    $273.74

    Facility

    $183.65

    $45.48 lower than Modesto for the office setting.

  • Arizona

    Arizona · 42405

    Office

    $299.08

    Facility

    $197.45

    $20.14 lower than Modesto for the office setting.

  • Colorado

    Colorado · 42405

    Office

    $316.59

    Facility

    $205.00

    $2.63 lower than Modesto for the office setting.

  • Connecticut

    Connecticut · 42405

    Office

    $326.43

    Facility

    $213.47

    $7.21 higher than Modesto for the office setting.

  • Delaware

    Delaware · 42405

    Office

    $303.75

    Facility

    $200.13

    $15.47 lower than Modesto for the office setting.

  • Fort Lauderdale

    Florida · 42405

    Office

    $321.74

    Facility

    $215.50

    $2.52 higher than Modesto for the office setting.

  • Rest Of Florida

    Florida · 42405

    Office

    $306.64

    Facility

    $206.38

    $12.58 lower than Modesto for the office setting.

  • Atlanta

    Georgia · 42405

    Office

    $313.29

    Facility

    $206.74

    $5.93 lower than Modesto for the office setting.

  • Rest Of Georgia

    Georgia · 42405

    Office

    $290.17

    Facility

    $196.62

    $29.05 lower than Modesto for the office setting.

  • Hawaii, Guam

    Hawaii · 42405

    Office

    $325.52

    Facility

    $206.27

    $6.30 higher than Modesto for the office setting.

  • Iowa

    Iowa · 42405

    Office

    $282.16

    Facility

    $186.20

    $37.06 lower than Modesto for the office setting.

  • Idaho

    Idaho · 42405

    Office

    $284.24

    Facility

    $187.75

    $34.98 lower than Modesto for the office setting.

  • East St. Louis

    Illinois · 42405

    Office

    $307.92

    Facility

    $211.43

    $11.30 lower than Modesto for the office setting.

  • Rest Of Illinois

    Illinois · 42405

    Office

    $299.71

    Facility

    $203.95

    $19.51 lower than Modesto for the office setting.

  • Suburban Chicago

    Illinois · 42405

    Office

    $324.51

    Facility

    $216.80

    $5.29 higher than Modesto for the office setting.

  • Indiana

    Indiana · 42405

    Office

    $285.72

    Facility

    $188.50

    $33.50 lower than Modesto for the office setting.

  • Kansas

    Kansas · 42405

    Office

    $281.79

    Facility

    $186.98

    $37.43 lower than Modesto for the office setting.

  • Kentucky

    Kentucky · 42405

    Office

    $285.37

    Facility

    $192.13

    $33.85 lower than Modesto for the office setting.

  • New Orleans

    Louisiana · 42405

    Office

    $298.26

    Facility

    $199.57

    $20.96 lower than Modesto for the office setting.

  • Rest Of Louisiana

    Louisiana · 42405

    Office

    $285.30

    Facility

    $192.48

    $33.92 lower than Modesto for the office setting.

  • Metropolitan Boston

    Massachusetts · 42405

    Office

    $345.17

    Facility

    $219.95

    $25.95 higher than Modesto for the office setting.

  • Rest Of Massachusetts

    Massachusetts · 42405

    Office

    $315.26

    Facility

    $204.82

    $3.96 lower than Modesto for the office setting.

  • Baltimore/Surr. Cntys

    Maryland · 42405

    Office

    $325.68

    Facility

    $213.14

    $6.46 higher than Modesto for the office setting.

  • Rest Of Maryland

    Maryland · 42405

    Office

    $308.98

    Facility

    $202.84

    $10.24 lower than Modesto for the office setting.

  • Rest Of Maine

    Maine · 42405

    Office

    $286.53

    Facility

    $190.04

    $32.69 lower than Modesto for the office setting.

  • Southern Maine

    Maine · 42405

    Office

    $299.64

    Facility

    $195.71

    $19.58 lower than Modesto for the office setting.

  • Detroit

    Michigan · 42405

    Office

    $311.10

    Facility

    $209.89

    $8.12 lower than Modesto for the office setting.

  • Rest Of Michigan

    Michigan · 42405

    Office

    $293.04

    Facility

    $197.29

    $26.18 lower than Modesto for the office setting.

  • Minnesota

    Minnesota · 42405

    Office

    $301.44

    Facility

    $193.52

    $17.78 lower than Modesto for the office setting.

  • Metropolitan Kansas City

    Missouri · 42405

    Office

    $295.46

    Facility

    $196.97

    $23.76 lower than Modesto for the office setting.

  • Metropolitan St. Louis

    Missouri · 42405

    Office

    $298.22

    Facility

    $198.37

    $21.00 lower than Modesto for the office setting.

  • Rest Of Missouri

    Missouri · 42405

    Office

    $281.34

    Facility

    $190.94

    $37.88 lower than Modesto for the office setting.

  • Mississippi

    Mississippi · 42405

    Office

    $277.55

    Facility

    $187.25

    $41.67 lower than Modesto for the office setting.

  • Montana**

    Montana · 42405

    Office

    $306.92

    Facility

    $202.04

    $12.30 lower than Modesto for the office setting.

  • North Carolina

    North Carolina · 42405

    Office

    $289.17

    Facility

    $191.31

    $30.05 lower than Modesto for the office setting.

  • North Dakota**

    North Dakota · 42405

    Office

    $297.83

    Facility

    $192.95

    $21.39 lower than Modesto for the office setting.

  • Nebraska

    Nebraska · 42405

    Office

    $283.33

    Facility

    $186.53

    $35.89 lower than Modesto for the office setting.

  • New Hampshire

    New Hampshire · 42405

    Office

    $312.52

    Facility

    $203.35

    $6.70 lower than Modesto for the office setting.

  • Northern Nj

    New Jersey · 42405

    Office

    $344.09

    Facility

    $222.43

    $24.87 higher than Modesto for the office setting.

  • Rest Of New Jersey

    New Jersey · 42405

    Office

    $329.61

    Facility

    $215.08

    $10.39 higher than Modesto for the office setting.

  • New Mexico

    New Mexico · 42405

    Office

    $294.88

    Facility

    $198.70

    $24.34 lower than Modesto for the office setting.

  • Nevada**

    Nevada · 42405

    Office

    $304.57

    Facility

    $199.59

    $14.65 lower than Modesto for the office setting.

  • Nyc Suburbs/Long Island

    New York · 42405

    Office

    $361.62

    Facility

    $236.92

    $42.40 higher than Modesto for the office setting.

  • Poughkpsie/N Nyc Suburbs

    New York · 42405

    Office

    $332.44

    Facility

    $217.60

    $13.22 higher than Modesto for the office setting.

  • Queens

    New York · 42405

    Office

    $353.97

    Facility

    $230.00

    $34.75 higher than Modesto for the office setting.

  • Rest Of New York

    New York · 42405

    Office

    $293.26

    Facility

    $193.62

    $25.96 lower than Modesto for the office setting.

  • Ohio

    Ohio · 42405

    Office

    $291.18

    Facility

    $195.43

    $28.04 lower than Modesto for the office setting.

  • Oklahoma

    Oklahoma · 42405

    Office

    $283.98

    Facility

    $190.32

    $35.24 lower than Modesto for the office setting.

  • Portland

    Oregon · 42405

    Office

    $325.04

    Facility

    $208.52

    $5.82 higher than Modesto for the office setting.

  • Rest Of Oregon

    Oregon · 42405

    Office

    $301.66

    Facility

    $197.20

    $17.56 lower than Modesto for the office setting.

  • Metropolitan Philadelphia

    Pennsylvania · 42405

    Office

    $319.37

    Facility

    $210.19

    $0.15 higher than Modesto for the office setting.

  • Rest Of Pennsylvania

    Pennsylvania · 42405

    Office

    $291.13

    Facility

    $194.85

    $28.09 lower than Modesto for the office setting.

  • Puerto Rico

    Puerto Rico · 42405

    Office

    $308.73

    Facility

    $202.70

    $10.49 lower than Modesto for the office setting.

  • Rhode Island

    Rhode Island · 42405

    Office

    $313.39

    Facility

    $205.05

    $5.83 lower than Modesto for the office setting.

  • South Carolina

    South Carolina · 42405

    Office

    $290.76

    Facility

    $193.86

    $28.46 lower than Modesto for the office setting.

  • South Dakota**

    South Dakota · 42405

    Office

    $296.75

    Facility

    $191.87

    $22.47 lower than Modesto for the office setting.

  • Tennessee

    Tennessee · 42405

    Office

    $283.21

    Facility

    $187.88

    $36.01 lower than Modesto for the office setting.

  • Austin

    Texas · 42405

    Office

    $316.02

    Facility

    $205.06

    $3.20 lower than Modesto for the office setting.

  • Beaumont

    Texas · 42405

    Office

    $289.42

    Facility

    $193.98

    $29.80 lower than Modesto for the office setting.

  • Brazoria

    Texas · 42405

    Office

    $302.80

    Facility

    $198.87

    $16.42 lower than Modesto for the office setting.

  • Dallas

    Texas · 42405

    Office

    $305.02

    Facility

    $200.56

    $14.20 lower than Modesto for the office setting.

  • Fort Worth

    Texas · 42405

    Office

    $303.39

    Facility

    $199.98

    $15.83 lower than Modesto for the office setting.

  • Galveston

    Texas · 42405

    Office

    $303.90

    Facility

    $199.76

    $15.32 lower than Modesto for the office setting.

  • Houston

    Texas · 42405

    Office

    $312.32

    Facility

    $208.18

    $6.90 lower than Modesto for the office setting.

  • Rest Of Texas

    Texas · 42405

    Office

    $296.15

    Facility

    $196.62

    $23.07 lower than Modesto for the office setting.

  • Utah

    Utah · 42405

    Office

    $294.42

    Facility

    $195.84

    $24.80 lower than Modesto for the office setting.

  • Virginia

    Virginia · 42405

    Office

    $299.33

    Facility

    $196.24

    $19.89 lower than Modesto for the office setting.

  • Virgin Islands

    United States Virgin Islands · 42405

    Office

    $308.73

    Facility

    $202.70

    $10.49 lower than Modesto for the office setting.

  • Vermont

    Vermont · 42405

    Office

    $297.54

    Facility

    $193.71

    $21.68 lower than Modesto for the office setting.

  • Rest Of Washington

    Washington · 42405

    Office

    $314.38

    Facility

    $203.94

    $4.84 lower than Modesto for the office setting.

  • Seattle (King Cnty)

    Washington · 42405

    Office

    $351.06

    Facility

    $222.37

    $31.84 higher than Modesto for the office setting.

  • Wisconsin

    Wisconsin · 42405

    Office

    $288.65

    Facility

    $188.17

    $30.57 lower than Modesto for the office setting.

  • West Virginia

    West Virginia · 42405

    Office

    $289.64

    Facility

    $198.50

    $29.58 lower than Modesto for the office setting.

  • Wyoming**

    Wyoming · 42405

    Office

    $302.96

    Facility

    $198.08

    $16.26 lower than Modesto for the office setting.

See how rates vary across the country

42405 · 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.

$273.74

$366.37

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

View all state and territory rates as a table
State / territoryRate rangeLocalities
AK$366.371
AL$277.451
AR$273.741
AZ$299.081
CA$319.22–$392.5629
CO$316.591
CT$326.431
DC$347.091
DE$303.751
FL$306.64–$337.943
GA$290.17–$313.292
GU$325.521
HI$325.521
IA$282.161
ID$284.241
IL$299.71–$328.534
IN$285.721
KS$281.791
KY$285.371
LA$285.30–$298.262
MA$315.26–$345.172
MD$308.98–$347.093
ME$286.53–$299.642
MI$293.04–$311.102
MN$301.441
MO$281.34–$298.223
MS$277.551
MT$306.921
NC$289.171
ND$297.831
NE$283.331
NH$312.521
NJ$329.61–$344.092
NM$294.881
NV$304.571
NY$293.26–$361.625
OH$291.181
OK$283.981
OR$301.66–$325.042
PA$291.13–$319.372
PR$308.731
RI$313.391
SC$290.761
SD$296.751
TN$283.211
TX$289.42–$316.028
UT$294.421
VA$299.33–$347.092
VI$308.731
VT$297.541
WA$314.38–$351.062
WI$288.651
WV$289.641
WY$302.961

Explore 42405 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 42405 in Modesto, the physician’s office rate is $319.22 and the facility-setting rate is $204.27: a difference of $114.95.

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 42405 in Modesto. This uses the base rate on this page, so the locality and release stay consistent.

Reference amount per service

$351.14

$319.22 × 110% = $351.14

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 42405 in Modesto.

PPRRVU2026_Oct_nonQPP.csv

5,028

Code
42405
Physician work
3.26
Practice expense
5.47
Malpractice
0.46

GPCI2026.csv

16

Locality
Modesto
Physician work
1.017
Practice expense
1.096
Malpractice
0.536
Office / nonfacility calculation for 42405 in Modesto
ComponentRVULocality factorAdjusted
Physician work3.26× 1.0173.3154
Practice expense5.47× 1.0965.9951
Malpractice0.46× 0.5360.2466
Total RVUs9.5571
Conversion factor× 33.4009

Office / nonfacility rate, Modesto$319.22

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

Open 42405 in the RVU calculator →

Explore RVUs, geographic factors and the full formula

Office / nonfacility

Office / nonfacility calculation inputs
ComponentRVULocal GPCI
Work3.261.017
Practice expense5.471.096
Malpractice0.460.536

(3.26 × 1.017 + 5.47 × 1.096 + 0.46 × 0.536) × $33.4009 = $319.22

Facility

Facility calculation inputs
ComponentRVULocal GPCI
Work3.261.017
Practice expense2.331.096
Malpractice0.460.536

(3.26 × 1.017 + 2.33 × 1.096 + 0.46 × 0.536) × $33.4009 = $204.27

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

42405 · Office / nonfacility

$319.22

Effective 2026-10-01

The base rate is $11.65 higher than on 2025-10-01, moving from $307.57 to $319.22 (3.8%).

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

    $307.57changed to$319.22

    • Conversion factor 32.3465 changed to 33.4009
    • Work RVU 3.34 changed to 3.26
    • Practice expense RVU 5.35 changed to 5.47
    • Malpractice RVU 0.49 changed to 0.46
    • 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: $307.57

    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$319.22$204.27RVU26D
2026-07-01$319.22$204.27RVU26C
2026-04-01$319.22$204.27RVU26B
2026-01-01$319.22$204.27RVU26A
2025-10-01$307.57$226.61RVU25D
2025-07-01$307.57$226.61RVU25C
2025-04-01$307.57$226.61RVU25B
2025-01-01$307.57$226.61RVU25A

42405 billing questions

How does 42405 differ from 42400?

42405 is for tissue obtained through an incision. 42400 is the needle-biopsy option; select the code that matches how the specimen was obtained.

Can the pathology examination be reported separately?

The biopsy code covers obtaining the specimen, not its microscopic evaluation. The pathology service may be reported separately when performed and otherwise reportable.

Can modifier 50 be used for biopsies on both sides?

No. CMS identifies bilateral adjustment as inappropriate for this code, so do not append modifier 50.

What postoperative care is included?

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

How does the multiple-procedure rule affect payment?

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

May an assistant or co-surgeon be reported?

Assistant-at-surgery payment is restricted for this code. 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 42405PPRRVU2026_Oct_nonQPP.csv, line 5,028 (RVU26D)
Geographic factors for ModestoGPCI2026.csv, line 16 (RVU26D)
Open CMS sourceHow this rate is calculatedBuild a fee sheet