No office rate
Both codes concern parotid duct diversion. 42509 is priced as a bilateral service; use the code that matches the specific diversion performed and documented.
On this page
CMS RVU26D · Effective 2026-10-01
42509 Parotid duct diversion Medicare reimbursement rates in Delaware
Reports surgery that redirects both parotid ducts, commonly to manage persistent drooling associated with neurologic or swallowing disorders. Compare 42509 office and facility rates across CMS payment localities in Delaware.
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 42509 in Delaware?
Delaware 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
$711.71
1 of 1 localities have a supported rate.
Payment area: Delaware
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 42509: Bilateral parotid duct diversion
Reports surgery that redirects both parotid ducts, commonly to manage persistent drooling associated with neurologic or swallowing disorders.
In bilateral parotid duct diversion, the surgeon reroutes the openings of both parotid ducts so saliva drains farther back in the mouth. Otolaryngologists and oral and maxillofacial surgeons may perform this operation for severe, persistent drooling, including in patients with neurologic conditions that impair saliva control. The service is performed in an operative setting and is distinct from repairing a damaged duct or injecting contrast to image the salivary system.
Report 42509 for the bilateral diversion service; the code is priced as bilateral, so modifier 50 does not increase payment. The operative report should establish that both parotid ducts were diverted and describe the work performed. The code has a 90-day global period, which includes the day-before preoperative visit and 90 days of related postoperative care. 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. Assistant-at-surgery payment requires documented medical necessity; co-surgeons and team surgery are not permitted.
CMS billing rules for 42509
- 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
- The code is already priced as bilateral; modifier 50 does not increase payment.
- 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 RVU11.47 · 53%
- Practice expense (office) RVU8.38 · 39%
- Malpractice RVU1.67 · 8%
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.
42509 compared with similar codes
Office rates for Delaware, from the same CMS release.
No office rate
This is another code with a parotid duct diversion descriptor. Check the full descriptor and operative details rather than treating it as interchangeable with bilateral 42509.
$444.13
42500 reports salivary duct repair. Choose it when the surgeon repairs a duct rather than rerouting both parotid duct openings.
$568.09
42505 is for a more involved salivary duct repair, not bilateral diversion of the parotid ducts.
Compare 42509 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
Delaware →
Office / nonfacility
Unavailable
Facility
$711.71
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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 42509 in Delaware.
PPRRVU2026_Oct_nonQPP.csv
5,045
- Code
- 42509
- Physician work
- 11.47
- Practice expense
- 8.38
- Malpractice
- 1.67
GPCI2026.csv
40
- Locality
- Delaware
- Physician work
- 1.005
- Practice expense
- 0.988
- Malpractice
- 0.899
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 11.47 | × 1.005 | 11.5274 |
| Practice expense | 8.38 | × 0.988 | 8.2794 |
| Malpractice | 1.67 | × 0.899 | 1.5013 |
| Total RVUs | 21.3081 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Delaware$711.71
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 11.47 | 1.005 |
| Practice expense | 8.38 | 0.988 |
| Malpractice | 1.67 | 0.899 |
(11.47 × 1.005 + 8.38 × 0.988 + 1.67 × 0.899) × $33.4009 = $711.71
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.
42509 billing questions
When should 42509 be chosen over 42507?
Use 42509 when the operative service diverts both parotid ducts. The related 42507 code is another parotid duct diversion code; select based on the specific procedure documented and the applicable code descriptor.
Should modifier 50 be appended?
No. 42509 is already priced as bilateral, and modifier 50 does not increase payment.
What documentation supports reporting 42509?
The operative report should identify diversion of both parotid ducts and describe the surgical work. Documentation of drooling or a neurologic condition alone does not establish that the bilateral diversion was performed.
Are related postoperative visits included?
Yes. The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.
Can an assistant surgeon or co-surgeon be reported?
Assistant-at-surgery payment is available only when medical necessity is documented. Co-surgeons and team surgery are not permitted for this code.
How does the multiple-procedure reduction affect 42509?
When it is performed with other procedures in the same session, the highest-valued procedure is paid in full and the other procedures are subject to the standard 50% reduction.
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.
5,04242500,,Repair salivary duct,A,,4.31,8.51,,4.45,,0.62,13.44,9.38,0,090,0.09,0.81,0.10,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,04342505,,Repair salivary duct,A,,6.16,10.13,,5.22,,0.90,17.19,12.28,0,090,0.09,0.81,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,04442507,,Parotid duct diversion,A,,6.09,6.24,NA,6.24,,0.89,13.22,13.22,0,090,0.09,0.81,0.10,2,2,2,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,04542509,,Parotid duct diversion,A,,11.47,8.38,NA,8.38,,1.67,21.52,21.52,0,090,0.09,0.81,0.10,2,2,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,0464250F,,Wrmng 4 surg normothermia,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
5,04742510,,Parotid duct diversion,A,,8.14,6.75,NA,6.75,,1.20,16.09,16.09,0,090,0.09,0.81,0.10,2,2,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,04842550,,Injection for salivary x-ray,A,,1.22,3.06,,0.22,,0.12,4.40,1.56,0,000,0.00,0.00,0.00,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
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
4109102,FL,03,FORT LAUDERDALE,1.000,1.013,1.808
4209102,FL,04,MIAMI,1.000,1.041,2.529
4309102,FL,99,REST OF FLORIDA,1.000,0.956,1.503