42815 Neck cyst excision Medicare reimbursement rates in Alabama

An otolaryngologist or head and neck surgeon uses this code for removal of a branchial cleft cyst, vestige, or fistulous tract that extends below the hyoid bone. The operation may involve tracing and removing the tract through deeper neck tissues; the excised tissue is typically submitted for pathologic examination. These cases are commonly performed in an operating room rather than an office setting.

Choose this code when the operative findings and procedure document extension below the hyoid, distinguishing it from the more limited excision reported with 42810. The operative report should identify the lesion or tract, its extent, the dissection performed, and whether the procedure was unilateral or bilateral. A 90-day global period includes the day-before preoperative visit and related postoperative care. For multiple procedures in one session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% reduction. Bilateral reporting with modifier 50 is paid at 150%. Assistant-at-surgery payment may be available; co-surgeons require supporting documentation, and team surgery is not permitted.