$222.35
Both address salivary gland abscess drainage; select 42305 for an external approach and 42300 for an intraoral approach.
On this page
CMS RVU26D · Effective 2026-10-01
42305 Salivary drainage Medicare reimbursement rates in Colorado
Report this procedure for surgical drainage of a salivary gland abscess approached through an external incision rather than through the mouth. Compare 42305 office and facility rates across CMS payment localities in Colorado.
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 42305 in Colorado?
Colorado 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
No supported rate
Facility setting
$390.22
1 of 1 localities have a supported rate.
Payment area: Colorado
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 42305: Extraoral salivary gland abscess drainage
Report this procedure for surgical drainage of a salivary gland abscess approached through an external incision rather than through the mouth.
This service involves opening and draining an abscess involving a salivary gland through an incision made outside the mouth. Otolaryngologists and oral and maxillofacial surgeons commonly perform it when an infected collection requires operative drainage by an external approach. The operative note should identify the abscess, the gland or involved site, the approach, and the drainage performed.
Choose this code for an abscess treated extraorally, not for an abscess drained through the mouth or for a salivary cyst or stone procedure. CMS assigns a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. If multiple procedures are performed in the same session, the highest-valued procedure is paid in full and the others are subject to the standard 50% multiple-procedure reduction. 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 42305
- Global period
- Major surgery with a 90-day global period: the day-before preoperative visit and 90 days of related postoperative care 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 RVU6.15 · 53%
- Practice expense (office) RVU4.47 · 39%
- Malpractice RVU0.90 · 8%
89
Medicare services in 2024 · #4970 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.
42305 compared with similar codes
Office rates for Colorado, from the same CMS release.
$189.94
This code addresses intraoral drainage of a salivary gland cyst. Code 42305 is for extraoral drainage of an abscess.
$246.09
42330 is for removing a submandibular salivary stone through an intraoral approach; 42305 is abscess drainage through an external incision.
Compare 42305 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
Colorado →
Office / nonfacility
Unavailable
Facility
$390.22
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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 42305 in Colorado.
PPRRVU2026_Oct_nonQPP.csv
5,020
- Code
- 42305
- Physician work
- 6.15
- Practice expense
- 4.47
- Malpractice
- 0.90
GPCI2026.csv
37
- Locality
- Colorado
- Physician work
- 1.012
- Practice expense
- 1.064
- Malpractice
- 0.781
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 6.15 | × 1.012 | 6.2238 |
| Practice expense | 4.47 | × 1.064 | 4.7561 |
| Malpractice | 0.90 | × 0.781 | 0.7029 |
| Total RVUs | 11.6828 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Colorado$390.22
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 6.15 | 1.012 |
| Practice expense | 4.47 | 1.064 |
| Malpractice | 0.9 | 0.781 |
(6.15 × 1.012 + 4.47 × 1.064 + 0.9 × 0.781) × $33.4009 = $390.22
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.
42305 billing questions
How is this distinguished from 42300?
42305 is for external drainage of a salivary gland abscess. Use 42300 when the abscess is drained through an intraoral approach.
Can this code be used for a salivary cyst or stone?
No. This service is for abscess drainage; cyst drainage and salivary stone removal are distinct procedures. The operative documentation should support the condition treated and the procedure performed.
What documentation supports the extraoral approach?
Document the abscess site, the external incision and approach, and the drainage performed. The record should distinguish the procedure from drainage through the mouth.
Can modifier 50 be reported?
No. CMS identifies bilateral adjustment as inappropriate for this code because of its descriptor or anatomy.
How does the 90-day global period affect follow-up billing?
The day-before preoperative visit and 90 days of related postoperative care are included in the global period. The code is classified as major surgery.
When is assistant-at-surgery payment allowed?
CMS allows assistant-at-surgery payment only when medical necessity is documented. 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.
5,01742281,,Insertion palate prosthesis,A,,1.93,5.03,,2.40,,0.27,7.23,4.60,0,010,0.10,0.80,0.10,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,01842299,,Unlisted px palate uvula,C,,0.00,0.00,,0.00,,0.00,0.00,0.00,0,YYY,0.00,0.00,0.00,2,0,2,1,1,9,,33.4009,09,0,99,0.00,0.00,0.00
5,01942300,,Drainage of salivary gland,A,,1.93,4.23,,2.05,,0.26,6.42,4.24,0,010,0.10,0.80,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,02042305,,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
3401112,CA,69,VISALIA,1.017,1.096,0.536
3501112,CA,70,YUBA CITY,1.017,1.096,0.536
3601112,CA,75,REST OF CALIFORNIA,1.017,1.096,0.536
3704112,CO,01,COLORADO,1.012,1.064,0.781
3813102,CT,00,CONNECTICUT,1.020,1.077,1.210
3912202,DC,01,DC + MD/VA SUBURBS,1.054,1.178,1.113
4012102,DE,01,DELAWARE,1.005,0.988,0.899