Billing code 42340: Stone removalMedicare rate & RVUs in Guam
Reports operative removal of a salivary stone when the procedure is complicated, with the gland, approach, and operative complexity documented.
Medicare pays $564.41 for 42340 in the office in Guam (Hawaii, Guam). 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 42340 covers
An otolaryngologist or oral and maxillofacial surgeon may remove a salivary calculus that obstructs a duct or gland and causes symptoms such as painful swelling, often around meals. The stone may involve a submandibular, sublingual, or parotid gland. This code represents the complicated procedure in the salivary-stone removal family; the operative report should identify the stone location, surgical approach, and features supporting the documented complexity.
Select this code when the performed stone-removal procedure meets the complicated level, rather than the uncomplicated service represented by 42330. The code has a 90-day global period: the day-before preoperative visit and related postoperative care during that period are included. For multiple procedures in one session, Medicare pays the highest-valued procedure in full and applies the standard reduction to the others. When performed bilaterally with modifier 50, payment is at 150%. 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.
42340 in Hawaii, Guam
| Payment locality | Office | Facility |
|---|---|---|
| Hawaii, Guam | $564.41 | $317.94 |
How the 42340 rate is calculated
Each of 42340’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 · 42340
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 4.60Practice expense 10.48Malpractice 0.66
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 42340
42340 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 42340
Stone removal
| 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) | 1 | Bilateral with modifier 50 pays 150% of the fee schedule amount. |
| 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 · 42340
Stone removal
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 50 · payment effect
With and without the modifier
42340 without 50 · national office
$525.73
Stone removal
42340-50 · Bilateral: 150%
$788.60
Both sides on one line with modifier 50 are paid at 150% of the fee schedule amount (subject to multiple-procedure rules with other procedures).
42340 compared with similar codes
Compare codes
42340 vs 42330 vs 42310 vs 42335: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 42330Salivary stone removal
- Use 42330 for uncomplicated salivary-stone removal. Choose 42340 when the documented procedure is complicated.
- 42310Salivary drainage
- 42310 describes salivary-gland drainage. 42340 is for operative removal of a salivary calculus.
- 42335Stone removal
- Both codes concern salivary-stone removal, but they represent distinct code-family services. Compare the full descriptor with the documented gland and procedure.
42340 billing questions
How is 42340 distinguished from 42330?
42340 is the complicated salivary-stone removal service; 42330 represents the uncomplicated service. The operative report should support the level selected.
What documentation supports the complicated level?
Document the affected gland or duct, the approach, the stone removal performed, and the operative circumstances that support classifying the procedure as complicated.
Can modifier 50 be used for bilateral stone removal?
CMS identifies this as a bilateral procedure. When reporting bilateral performance with modifier 50, payment is at 150%.
What postoperative care is included?
The 90-day global period includes the day-before preoperative visit and related postoperative care during the 90 days after surgery.
When is an assistant at surgery payable?
Assistant-at-surgery payment is allowed only when medical necessity is documented. Co-surgeons and team surgery are not permitted for this code.
How are multiple procedures in the same session paid?
The highest-valued procedure is paid in full, and the other procedures are subject to the standard multiple-procedure 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 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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