$412.26
42500 is for a simple primary salivary duct procedure. Use 42505 when the surgeon performs complicated secondary reconstruction.
On this page
CMS RVU26D · Effective 2026-10-01
42505 Salivary duct repair Medicare reimbursement rates in Iowa
Reports complex secondary reconstruction of a salivary duct, such as repair of a scarred or injured duct when a simple primary procedure is insufficient. Compare 42505 office and facility rates across CMS payment localities in Iowa.
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 42505 in Iowa?
Iowa 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
$527.27
1 of 1 localities have a supported rate.
Payment area: Iowa
One mapped payment locality.
Facility setting
$377.22
1 of 1 localities have a supported rate.
Payment area: Iowa
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.
Otolaryngology surgery
About 42505: Complicated secondary salivary duct repair
Reports complex secondary reconstruction of a salivary duct, such as repair of a scarred or injured duct when a simple primary procedure is insufficient.
This service involves complex reconstruction of a salivary duct after an earlier procedure, injury, or disease has left the duct damaged or scarred. The surgeon restores duct continuity or function through a secondary repair; the work may involve reconstructing or repositioning the duct. Otolaryngologists and oral and maxillofacial surgeons typically perform it in an operating room, including for parotid or other major salivary duct problems.
Choose this code when the operative work is a complicated secondary repair, rather than a simple primary duct procedure. Document the reason for secondary reconstruction, the condition of the duct, and the repair performed. The day-before preoperative visit and related postoperative care through day 90 are included in the global period. When other procedures are performed in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% multiple-procedure reduction. Medicare does not pay an assistant at surgery for this service under the statutory restriction; co-surgeons and team surgery are not permitted.
CMS billing rules for 42505
- 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
- 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 RVU6.16 · 36%
- Practice expense (office) RVU10.13 · 59%
- Malpractice RVU0.90 · 5%
282
Medicare services in 2024 · #4041 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.
42505 compared with similar codes
Office rates for Iowa, from the same CMS release.
No office rate
42507 describes parotid duct transposition. Choose 42505 for complicated secondary repair of the duct rather than a procedure whose goal is transposition.
No office rate
42509 is a parotid duct diversion procedure. The operative objective is diversion, whereas 42505 represents complicated secondary duct repair.
Compare 42505 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
Iowa →
Office / nonfacility
$527.27
Facility
$377.22
Need rates for a whole code list?
Fee-sheet and API access are in early access. Tell us which codes and locations your team needs.
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 42505 in Iowa.
PPRRVU2026_Oct_nonQPP.csv
5,043
- Code
- 42505
- Physician work
- 6.16
- Practice expense
- 10.13
- Malpractice
- 0.90
GPCI2026.csv
53
- Locality
- Iowa
- Physician work
- 1.000
- Practice expense
- 0.915
- Malpractice
- 0.397
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 6.16 | × 1.000 | 6.1600 |
| Practice expense | 10.13 | × 0.915 | 9.2690 |
| Malpractice | 0.90 | × 0.397 | 0.3573 |
| Total RVUs | 15.7863 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Iowa$527.27
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 6.16 | 1 |
| Practice expense | 10.13 | 0.915 |
| Malpractice | 0.9 | 0.397 |
(6.16 × 1 + 10.13 × 0.915 + 0.9 × 0.397) × $33.4009 = $527.27
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 6.16 | 1 |
| Practice expense | 5.22 | 0.915 |
| Malpractice | 0.9 | 0.397 |
(6.16 × 1 + 5.22 × 0.915 + 0.9 × 0.397) × $33.4009 = $377.22
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.
42505 billing questions
How does this differ from 42500?
Use 42505 for a complicated secondary repair, such as reconstruction of a previously treated or scarred duct. Code 42500 describes a simple primary duct procedure.
Is postoperative care separately reportable?
Related postoperative care through day 90 is included in the global period, along with the day-before preoperative visit.
Can modifier 50 be used?
No. The descriptor and anatomy make modifier 50 inappropriate for this code.
Can an assistant surgeon or co-surgeon be reported?
Medicare does not pay an assistant at surgery for this service under the statutory restriction. Co-surgeons and team surgery are not permitted.
How is this paid with another procedure in the same session?
The highest-valued procedure is paid in full; other procedures in the same session are subject to the standard 50% multiple-procedure reduction.
What documentation supports choosing 42505?
Describe why secondary reconstruction was needed, the duct's condition, and the operative repair. The record should support complicated secondary work rather than a simple primary procedure.
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.
5,0404245F,,Pt instr nrml activities,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
5,0414248F,,Pt instr no bd rest 4 days/>,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
5,04242500,,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
5006102,IL,15,SUBURBAN CHICAGO,1.007,1.027,1.772
5106102,IL,99,REST OF ILLINOIS,1.000,0.913,1.563
5208102,IN,00,INDIANA,1.000,0.927,0.486
5305102,IA,00,IOWA,1.000,0.915,0.397
5405202,KS,00,KANSAS,1.000,0.904,0.504
5515102,KY,00,KENTUCKY,1.000,0.889,0.915
5607202,LA,01,NEW ORLEANS,1.000,0.941,1.136