No office rate
Both address branchial cleft cysts or remnants, but 42810 is limited to lesions within skin and subcutaneous tissue. Deeper extension or extension into the pharynx is the distinguishing feature for 42815.
On this page
CMS RVU26D · Effective 2026-10-01
42810 Neck cyst excision Medicare reimbursement rates in Colorado
Reports removal of a superficial branchial cleft cyst or remnant confined to the skin and subcutaneous tissue, without deeper extension. Compare 42810 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 42810 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
$400.65
1 of 1 localities have a supported rate.
Payment area: Colorado
One mapped payment locality.
Facility setting
$264.18
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.
ENT surgery
About 42810: Superficial branchial cleft remnant excision
Reports removal of a superficial branchial cleft cyst or remnant confined to the skin and subcutaneous tissue, without deeper extension.
This code describes surgical removal of a branchial cleft cyst or remnant when it is limited to the skin and tissue just beneath it. Otolaryngologists and other surgeons may perform the procedure for a congenital neck lump or draining opening attributable to a superficial branchial cleft remnant. The operative report should identify the lesion and its location and show that its extent remained within the skin and subcutaneous tissues.
Choose this code based on the documented depth and extent, not simply the diagnosis of a neck cyst. A remnant extending deeper than the subcutaneous tissues or into the pharynx points to 42815 instead. The procedure has a 90-day global period, including the day-before preoperative visit and related postoperative care during that period. When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% reduction. For bilateral procedures, modifier 50 is paid at 150%. Assistant-at-surgery payment may be available; co-surgeons and team surgery are not permitted.
CMS billing rules for 42810
- 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 procedure with modifier 50 is paid at 150%.
- Assistant at surgery
- Assistant at surgery may be paid.
- Co-surgeons
- Co-surgeons not permitted.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU3.30 · 29%
- Practice expense (office) RVU7.79 · 67%
- Malpractice RVU0.47 · 4%
45
Medicare services in 2024 · #5421 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.
42810 compared with similar codes
Office rates for Colorado, from the same CMS release.
No office rate
Use 60281 for a primary thyroglossal duct cyst or sinus. A branchial cleft cyst or remnant confined to skin and subcutaneous tissue is reported with 42810.
$477.75
This code is for a qualifying soft-tissue mass of the neck, not a branchial cleft remnant. The documented diagnosis and operative findings determine which service applies.
Compare 42810 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
$400.65
Facility
$264.18
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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 42810 in Colorado.
PPRRVU2026_Oct_nonQPP.csv
5,077
- Code
- 42810
- Physician work
- 3.30
- Practice expense
- 7.79
- Malpractice
- 0.47
GPCI2026.csv
37
- Locality
- Colorado
- Physician work
- 1.012
- Practice expense
- 1.064
- Malpractice
- 0.781
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 3.30 | × 1.012 | 3.3396 |
| Practice expense | 7.79 | × 1.064 | 8.2886 |
| Malpractice | 0.47 | × 0.781 | 0.3671 |
| Total RVUs | 11.9952 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Colorado$400.65
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 3.3 | 1.012 |
| Practice expense | 7.79 | 1.064 |
| Malpractice | 0.47 | 0.781 |
(3.3 × 1.012 + 7.79 × 1.064 + 0.47 × 0.781) × $33.4009 = $400.65
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 3.3 | 1.012 |
| Practice expense | 3.95 | 1.064 |
| Malpractice | 0.47 | 0.781 |
(3.3 × 1.012 + 3.95 × 1.064 + 0.47 × 0.781) × $33.4009 = $264.18
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.
42810 billing questions
How do I distinguish 42810 from 42815?
Use 42810 when the branchial cleft cyst or remnant is confined to skin and subcutaneous tissue. Use 42815 when the operative documentation describes extension beneath the subcutaneous tissues or into the pharynx.
What documentation supports 42810?
Document the branchial cleft origin, neck location, and operative findings showing the lesion remained within skin and subcutaneous tissue. The depth and extent of the excision distinguish this code from 42815.
What postoperative care is included?
The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.
How is 42810 handled with another procedure in the same session?
Under the standard multiple procedure reduction, the highest-valued procedure is paid in full and the other procedures are paid at 50%.
Can modifier 50 be used for bilateral excision?
The CMS bilateral rule specifies modifier 50, with payment at 150% for a bilateral procedure.
Can an assistant or co-surgeon be reported?
Assistant-at-surgery payment may be available. Co-surgeons and team surgery are not permitted 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 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.
5,07442808,,Excise pharynx lesion,A,,2.29,4.38,,1.80,,0.35,7.02,4.44,0,010,0.10,0.80,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,07542809,,Remove pharynx foreign body,A,,1.81,4.33,,1.41,,0.28,6.42,3.50,0,010,0.10,0.80,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,0764280F,,Pcp prophylax rxd 3mon low %,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
5,07742810,,Excision of neck cyst,A,,3.30,7.79,,3.95,,0.47,11.56,7.72,0,090,0.09,0.81,0.10,2,1,2,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,07842815,,Excision of neck cyst,A,,7.13,6.14,NA,6.14,,1.05,14.32,14.32,0,090,0.09,0.81,0.10,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,07942820,,Remove tonsils and adenoids,A,,4.11,3.11,NA,3.11,,0.59,7.81,7.81,0,090,0.09,0.81,0.10,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,08042821,,Remove tonsils and adenoids,A,,4.25,3.29,NA,3.29,,0.61,8.15,8.15,0,090,0.09,0.81,0.10,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
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