$495.15
42600 is for direct closure of a salivary fistula. Use 42665 when the surgeon ligates a duct to interrupt salivary flow.
On this page
CMS RVU26D · Effective 2026-10-01
42665 Salivary duct surgery Medicare reimbursement rates in Iowa
Reports operative ligation of a salivary duct, such as when a surgeon intentionally interrupts salivary flow for a selected clinical indication. Compare 42665 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 42665 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
$337.79
1 of 1 localities have a supported rate.
Payment area: Iowa
One mapped payment locality.
Facility setting
$181.31
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.
Salivary gland surgery
About 42665: Salivary duct ligation
Reports operative ligation of a salivary duct, such as when a surgeon intentionally interrupts salivary flow for a selected clinical indication.
The surgeon exposes and ties off a salivary duct to interrupt flow from the associated gland. This may be considered for selected patients with troublesome drooling or persistent salivary leakage. Otolaryngologists, oral and maxillofacial surgeons, and head and neck surgeons typically perform the operation in a surgical setting. The operative note should identify the duct and gland treated, the reason for ligation, and the technique used.
Report 42665 when the procedure actually ligates the duct; dilation of a narrowed duct and direct closure of a salivary fistula are different services. 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% multiple-procedure reduction. The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care. Assistant-at-surgery payment requires documentation of medical necessity. Co-surgeons and team surgery are not permitted.
CMS billing rules for 42665
- 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
- 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 RVU2.56 · 23%
- Practice expense (office) RVU8.09 · 73%
- Malpractice RVU0.38 · 3%
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.
42665 compared with similar codes
Office rates for Iowa, from the same CMS release.
$70.52
42650 describes dilation of a salivary duct. It is not the code for tying off the duct.
$93.87
42660 is also a salivary duct dilation service. Select 42665 when the operative service is duct ligation rather than dilation.
Compare 42665 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
$337.79
Facility
$181.31
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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 42665 in Iowa.
PPRRVU2026_Oct_nonQPP.csv
5,057
- Code
- 42665
- Physician work
- 2.56
- Practice expense
- 8.09
- Malpractice
- 0.38
GPCI2026.csv
53
- Locality
- Iowa
- Physician work
- 1.000
- Practice expense
- 0.915
- Malpractice
- 0.397
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 2.56 | × 1.000 | 2.5600 |
| Practice expense | 8.09 | × 0.915 | 7.4024 |
| Malpractice | 0.38 | × 0.397 | 0.1509 |
| Total RVUs | 10.1132 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Iowa$337.79
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 2.56 | 1 |
| Practice expense | 8.09 | 0.915 |
| Malpractice | 0.38 | 0.397 |
(2.56 × 1 + 8.09 × 0.915 + 0.38 × 0.397) × $33.4009 = $337.79
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 2.56 | 1 |
| Practice expense | 2.97 | 0.915 |
| Malpractice | 0.38 | 0.397 |
(2.56 × 1 + 2.97 × 0.915 + 0.38 × 0.397) × $33.4009 = $181.31
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.
42665 billing questions
How is duct ligation different from salivary duct dilation?
Ligation intentionally interrupts salivary flow. Dilation opens a narrowed duct to restore or improve flow.
Is ligation the same as closing a salivary fistula?
No. Ligation ties off a duct, while fistula closure directly repairs the abnormal communication. Report the procedure actually performed.
What documentation supports 42665?
The operative note should identify the duct and gland, the clinical reason for interruption, and the ligation performed.
How does the 90-day global period affect postoperative care?
The day-before preoperative visit and 90 days of related postoperative care are included in the global period.
Can an assistant surgeon be reported?
Assistant-at-surgery payment is allowed only when the record documents medical necessity. Co-surgeons and team surgery are not permitted for this code.
What happens when another procedure is performed in the same session?
The highest-valued procedure is paid in full, and 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 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.
5,05442650,,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
5,0584266F,,No wet-dry drssings 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
5,0594267F,,Comprssion thxpy prescribed,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
5,0604268F,,Pt ed re comp thxpy rcvd,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