$164.44
Both codes describe drainage of a submandibular abscess. Select 42320 for an external approach and 42310 for an intraoral approach.
On this page
CMS RVU26D · Effective 2026-10-01
42320 Abscess drainage Medicare reimbursement rates in Alabama
Reports surgical drainage of an abscess involving the submandibular salivary gland when the surgeon uses an external approach through the neck. Compare 42320 office and facility rates across CMS payment localities in Alabama.
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.
What does Medicare pay for 42320 in Alabama?
Alabama has 1 payment locality in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the payment area shown below, using the same CMS release.
Office / nonfacility
$235.00
1 of 1 localities have a supported rate.
Payment area: Alabama
One mapped payment locality.
Facility setting
$147.90
1 of 1 localities have a supported rate.
Payment area: Alabama
One mapped payment locality.
These are locality ranges, not averages or address-specific quotes. A facility-setting amount covers the physician service; it does not include a hospital’s separate bill. Choose a locality below to inspect its calculation, compare other payment areas, or price a percentage of Medicare.
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 Alabama, from the same CMS release.
$193.00
This code is for simple parotid abscess drainage, rather than drainage involving the submandibular gland.
No office rate
This code is for complicated parotid abscess drainage. The gland and documented procedure, not just the abscess, distinguish it from 42320.
$213.87
42330 describes removal of a salivary stone; 42320 describes drainage of a submandibular abscess through an external approach.
Compare 42320 by payment locality
Find the payment area for your service address, then open its rate page for calculation inputs, release history and the percentage-of-Medicare tool. A city may cross payment-area boundaries; the ZIP lookup above helps resolve the location.
1 of 1 payment localities
Alabama →
Office / nonfacility
$235.00
Facility
$147.90
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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 Alabama.
PPRRVU2026_Oct_nonQPP.csv
5,023
- Code
- 42320
- Physician work
- 2.34
- Practice expense
- 5.14
- Malpractice
- 0.35
GPCI2026.csv
4
- Locality
- Alabama
- Physician work
- 1.000
- Practice expense
- 0.875
- Malpractice
- 0.566
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 2.34 | × 1.000 | 2.3400 |
| Practice expense | 5.14 | × 0.875 | 4.4975 |
| Malpractice | 0.35 | × 0.566 | 0.1981 |
| Total RVUs | 7.0356 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Alabama$235.00
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 2.34 | 1 |
| Practice expense | 5.14 | 0.875 |
| Malpractice | 0.35 | 0.566 |
(2.34 × 1 + 5.14 × 0.875 + 0.35 × 0.566) × $33.4009 = $235.00
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 2.34 | 1 |
| Practice expense | 2.16 | 0.875 |
| Malpractice | 0.35 | 0.566 |
(2.34 × 1 + 2.16 × 0.875 + 0.35 × 0.566) × $33.4009 = $147.90
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.
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.
5,02042305,,Drainage of salivary gland,A,,6.15,4.47,NA,4.47,,0.90,11.52,11.52,0,090,0.09,0.81,0.10,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,0214230F,,Anticonv thxpy for 6 mos/>,I,,0.00,0.00,,0.00,,0.00,0.00,0.00,9,XXX,0.00,0.00,0.00,9,9,9,9,9,9,,33.4009,09,0,99,0.00,0.00,0.00
5,02242310,,Drainage of salivary gland,A,,1.57,3.69,,2.04,,0.22,5.48,3.83,0,010,0.10,0.80,0.10,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,02342320,,Drainage of salivary gland,A,,2.34,5.14,,2.16,,0.35,7.83,4.85,0,010,0.10,0.80,0.10,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,02442330,,Removal of salivary stone,A,,2.20,4.59,,1.97,,0.33,7.12,4.50,0,010,0.10,0.80,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,02542335,,Removal of salivary stone,A,,3.32,9.03,,3.37,,0.48,12.83,7.17,0,090,0.09,0.81,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,02642340,,Removal of salivary stone,A,,4.60,10.48,,3.99,,0.66,15.74,9.25,0,090,0.09,0.81,0.10,2,1,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1ADDENDUM E. FINAL CY 2026 GEOGRAPHIC PRACTICE COST INDICES (GPCIs) BY STATE AND MEDICARE LOCALITY,,,,,,
2,,,,,,
3Medicare Administrative Contractor (MAC),State,Locality Number,Locality Name,2026 PW GPCI (with 1.0 Floor)***,2026 PE GPCI,2026 MP GPCI
410112,AL,00,ALABAMA,1.000,0.875,0.566
502102,AK,01,ALASKA*,1.500,1.065,0.551
603102,AZ,00,ARIZONA,1.000,0.969,0.856
707102,AR,13,ARKANSAS,1.000,0.859,0.515