Billing code 42408: Salivary cystMedicare rate & RVUs in Alabama
Report this service when a surgeon removes a salivary cyst, such as a ranula, rather than draining it or taking a diagnostic sample.
Medicare pays $511.13 for 42408 in the office in Alabama (Alabama). Which amount applies depends on the service address.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
On this page 9 sections
What 42408 covers
billing code 42408 represents surgical removal of a cyst arising from salivary tissue. A typical presentation is a persistent or recurrent fluid-filled lesion in the floor of the mouth, such as a ranula. Otolaryngologists and oral and maxillofacial surgeons commonly perform the procedure in an operating room or another setting suited to the lesion and anesthesia. The operative note should identify the cyst’s location and approach, describe what was removed, and state whether tissue was sent for pathology.
Report 42408 for excision; opening the cyst to release its contents is represented by 42409, while a biopsy code describes sampling. Document the diagnosis, operative findings, and excision performed. CMS assigns a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. When multiple procedures are performed in one session, the highest-valued procedure is paid in full and others are subject to the standard 50% reduction. Modifier 50 is inappropriate for this code. Assistant-at-surgery payment requires documented medical necessity; co-surgeons and team surgery are not permitted.
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.
42408 in Alabama
| Payment locality | Office | Facility |
|---|---|---|
| Alabama | $511.13 | $296.03 |
How the 42408 rate is calculated
Each of 42408’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.
How the rate is built · 42408
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 4.54Practice expense 11.88Malpractice 0.65
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 42408
42408 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 42408
Salivary cyst
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 090 | Major surgery: the day before, the day of, and 90 days after are included. |
| Multiple procedures | 2 | Standard reduction: highest-valued procedure at 100%, others at 50%. |
| Bilateral (modifier 50) | 0 | The 150% bilateral adjustment doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 0 | Not paid without supporting documentation. |
| Co-surgeons (62) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
| Split (54/55/56) | 0.09/0.81/0.10 | Share of the payment for pre-op, the procedure itself, and post-op care. |
Global surgery period · 42408
Salivary cyst
90-day global period ends
Dec 30, 2026
Covers Sep 30, 2026 through Dec 30, 2026 (92 days, including the day before surgery).
Visit on Oct 31, 2026
Day 30 of the 90-day post-op period: related follow-up care is included in the surgical payment.
Pre-op dayGlobal period
What modifiers do to the payment
Modifier 51 · payment effect
With and without the modifier
42408 without 51 · national office
$570.15
Salivary cyst
42408-51 · Second procedure: 50%
$285.08
When this isn’t the highest-valued procedure in the session, Medicare pays 50% of its fee schedule amount (the highest is paid at 100%).
42408 compared with similar codes
Compare codes
42408 vs 42409 vs 42400 vs 42405 vs 42410: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 42409Salivary cyst drainage
- 42408 is for excision of the cyst; 42409 describes drainage. Select according to the procedure actually performed.
- 42400Salivary biopsy
- 42400 represents salivary gland biopsy. It is for tissue sampling, not definitive excision of a salivary cyst.
- 42405Salivary gland biopsy
- 42405 is also a salivary gland biopsy code. Use 42408 when the operative service removes the cyst rather than sampling it.
- 42410Parotid excision
- 42410 concerns excision involving the parotid gland or a parotid lesion. 42408 is for excision of a salivary cyst.
42408 billing questions
When should 42408 be chosen over 42409?
Use 42408 when the surgeon removes the salivary cyst. Use 42409 when the documented procedure drains the cyst rather than excising it.
Can a biopsy code be reported for the same cyst?
A biopsy code describes diagnostic tissue sampling, not removal of the cyst. The operative documentation should establish whether the surgeon sampled tissue or excised the cyst.
Can modifier 50 be used for bilateral cyst excision?
No. CMS identifies bilateral adjustment as inappropriate for 42408, so modifier 50 should not be used.
What postoperative care is included?
The 90-day global period includes the preoperative visit on the day before surgery and 90 days of related postoperative care.
How is 42408 affected when other procedures occur in the same session?
CMS applies the standard multiple-procedure reduction: the highest-valued procedure is paid in full, and other procedures are subject to a 50% reduction.
What documentation supports assistant-at-surgery payment?
The record must document the medical necessity of the assistant. CMS does not permit co-surgeon or team-surgery payment for this code.
Where these rates come from
FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.
CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027
Show the CMS file lines behind this rate
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