$108.19
The approach determines the choice: 42650 is for percutaneous duct dilation, while 42660 is for dilation through the mouth.
On this page
CMS RVU26D · Effective 2026-10-01
42650 Salivary duct dilation Medicare reimbursement rates in Hawaii
Percutaneous salivary duct dilation widens a narrowed duct through a skin approach, typically to address impaired salivary drainage from duct stenosis. Compare 42650 office and facility rates across CMS payment localities in Hawaii.
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 42650 in Hawaii?
Hawaii 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
$81.86
1 of 1 localities have a supported rate.
Payment area: Hawaii, Guam
One mapped payment locality.
Facility setting
$55.28
1 of 1 localities have a supported rate.
Payment area: Hawaii, Guam
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 duct surgery
About 42650: Percutaneous salivary duct dilation
Percutaneous salivary duct dilation widens a narrowed duct through a skin approach, typically to address impaired salivary drainage from duct stenosis.
This service widens a narrowed salivary duct using a percutaneous approach. It may be performed when duct stenosis interferes with saliva drainage, such as in a patient with obstructive salivary symptoms. Otolaryngologists and other surgeons who treat salivary duct disorders typically perform it in an office procedure setting or a facility, depending on the case and practice arrangement. The route matters: dilation performed through the mouth is represented by a different code.
Report the service when the physician performs percutaneous duct dilation, and document the treated duct, the access route, the narrowing or drainage problem, and the work performed. The code has a 0-day global period, so same-day preoperative and postoperative care is included. 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 multiple-procedure reduction. Modifier 50 is inappropriate for this code. Medicare does not pay an assistant at surgery, and co-surgeons and team surgery are not permitted.
CMS billing rules for 42650
- Global period
- Minor procedure with a 0-day global period: same-day preoperative and postoperative care is 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
- Statutory restriction: assistant at surgery is not paid.
- Co-surgeons
- Co-surgeons not permitted.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU0.75 · 33%
- Practice expense (office) RVU1.44 · 63%
- Malpractice RVU0.11 · 5%
429
Medicare services in 2024 · #3673 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.
42650 compared with similar codes
Office rates for Hawaii, from the same CMS release.
Compare 42650 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
Hawaii, Guam →
Office / nonfacility
$81.86
Facility
$55.28
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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 42650 in Hawaii, Guam.
PPRRVU2026_Oct_nonQPP.csv
5,054
- Code
- 42650
- Physician work
- 0.75
- Practice expense
- 1.44
- Malpractice
- 0.11
GPCI2026.csv
46
- Locality
- Hawaii, Guam
- Physician work
- 1.000
- Practice expense
- 1.137
- Malpractice
- 0.579
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 0.75 | × 1.000 | 0.7500 |
| Practice expense | 1.44 | × 1.137 | 1.6373 |
| Malpractice | 0.11 | × 0.579 | 0.0637 |
| Total RVUs | 2.4510 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Hawaii, Guam$81.86
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 0.75 | 1 |
| Practice expense | 1.44 | 1.137 |
| Malpractice | 0.11 | 0.579 |
(0.75 × 1 + 1.44 × 1.137 + 0.11 × 0.579) × $33.4009 = $81.86
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 0.75 | 1 |
| Practice expense | 0.74 | 1.137 |
| Malpractice | 0.11 | 0.579 |
(0.75 × 1 + 0.74 × 1.137 + 0.11 × 0.579) × $33.4009 = $55.28
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.
42650 billing questions
How is this code distinguished from 42660?
Choose 42650 for a percutaneous approach to dilating the salivary duct. Code 42660 represents dilation performed through an intraoral approach.
What documentation supports reporting this service?
Document the duct treated, the percutaneous route, the stenosis or drainage problem, and the dilation performed.
Is modifier 50 appropriate when both sides are treated?
No. The CMS bilateral adjustment does not apply, and modifier 50 is inappropriate for this code.
Can an assistant surgeon or co-surgeon be reported?
Medicare does not pay an assistant at surgery for this service. Co-surgeons and team surgery are not permitted.
How are other procedures in the same session paid?
When multiple procedures are performed in one session, the highest-valued procedure is paid in full and the others are subject to the standard multiple-procedure reduction.
Does the code include same-day postoperative care?
Yes. The 0-day global period includes same-day preoperative and postoperative care.
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.
5,05142600,,Closure of salivary fistula,A,,4.82,10.63,,4.04,,0.70,16.15,9.56,0,090,0.09,0.81,0.10,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,0524260F,,Wound srfc culturetech used,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
5,0534261F,,Tech other than surfc cultr,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
5,05442650,,Dilation of salivary duct,A,,0.75,1.44,,0.74,,0.11,2.30,1.60,0,000,0.00,0.00,0.00,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,0554265F,,Wet-dry dressings rx recmd,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
5,05642660,,Dilation of salivary duct,A,,1.10,1.80,,0.84,,0.16,3.06,2.10,0,000,0.00,0.00,0.00,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,05742665,,Ligation of salivary duct,A,,2.56,8.09,,2.97,,0.38,11.03,5.91,0,090,0.09,0.81,0.10,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4309102,FL,99,REST OF FLORIDA,1.000,0.956,1.503
4410212,GA,01,ATLANTA,1.003,1.016,1.201
4510212,GA,99,REST OF GEORGIA,1.000,0.892,1.192
4601212,HI,01,"HAWAII, GUAM",1.000,1.137,0.579
4702202,ID,00,IDAHO,1.000,0.920,0.473
4806102,IL,16,CHICAGO,1.007,1.005,2.295
4906102,IL,12,EAST ST. LOUIS,1.000,0.920,2.014