$286.53–$299.64
Choose 42400 for needle-based gland tissue sampling; 42405 describes obtaining the biopsy through an incision.
On this page
CMS RVU26D · Effective 2026-10-01
42400 Salivary biopsy Medicare reimbursement rates in Maine
Reports needle-based tissue sampling of a salivary gland to evaluate a gland abnormality, such as a palpable mass or suspected neoplasm. Compare 42400 office and facility rates across CMS payment localities in Maine.
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 42400 in Maine?
Maine has 2 payment localities in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the 2 payment areas shown below, using the same CMS release.
Office / nonfacility
$88.20–$92.94
2 of 2 localities have a supported rate.
Facility setting
$45.18–$46.60
2 of 2 localities have a supported rate.
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.
ENT procedure
About 42400: Salivary gland needle biopsy
Reports needle-based tissue sampling of a salivary gland to evaluate a gland abnormality, such as a palpable mass or suspected neoplasm.
This service samples tissue from a salivary gland with a needle for pathologic evaluation, commonly when a clinician is assessing a palpable gland mass or another suspicious gland abnormality. Otolaryngologists and other physicians who evaluate head and neck lesions may perform it in an office or facility setting. It is distinct from an incisional biopsy, which obtains tissue through an incision, and from fine-needle aspiration services that collect cells for cytology.
Report the biopsy when documentation supports needle-based tissue sampling of the gland, including the site sampled and the clinical reason for evaluation. The 0-day global period includes same-day preoperative and postoperative care. When multiple procedures are performed in one session, the highest-valued procedure is paid in full and the others are subject to the standard 50% multiple-procedure reduction. Modifier 50 is inappropriate. Medicare does not pay an assistant at surgery, and co-surgeons and team surgery are not permitted for this service.
CMS billing rules for 42400
- 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 RVU0.76 · 27%
- Practice expense (office) RVU1.99 · 70%
- Malpractice RVU0.08 · 3%
3.6K
Medicare services in 2024 · #2054 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.
42400 compared with similar codes
Office rates for Maine, from the same CMS release.
$94.08–$98.58
10021 is for fine-needle aspiration without imaging guidance, which collects cells for cytology; 42400 reports needle-based salivary gland tissue biopsy.
$123.79–$129.46
10005 reports ultrasound-guided fine-needle aspiration. Use 42400 for needle-based tissue biopsy rather than aspiration cytology.
Compare 42400 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.
2 of 2 payment localities
Rest Of Maine →
Office / nonfacility
$88.20
Facility
$45.18
Southern Maine →
Office / nonfacility
$92.94
Facility
$46.60
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42400 billing questions
How does this differ from an incisional salivary gland biopsy?
42400 is for needle-based tissue sampling. Use 42405 when the physician obtains the biopsy through an incision.
Can this be reported for fine-needle aspiration?
Fine-needle aspiration services use the aspiration biopsy code set, such as 10021 without imaging guidance or 10005 with ultrasound guidance. Do not select 42400 solely because the target is a salivary gland.
Is same-day postoperative care included?
Yes. The 0-day global period includes same-day preoperative and postoperative care.
Can modifier 50 be used for biopsies on both sides?
No. The CMS bilateral adjustment does not apply to 42400, and modifier 50 is inappropriate.
How are other procedures in the same session paid?
The highest-valued procedure is paid in full, with the standard multiple-procedure reduction applied to the other procedures. Medicare does not pay an assistant at surgery for 42400; co-surgeons and team surgery are not permitted.
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.
5,02442330,,Removal of salivary stone,A,,2.20,4.59,,1.97,,0.33,7.12,4.50,0,010,0.10,0.80,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,02542335,,Removal of salivary stone,A,,3.32,9.03,,3.37,,0.48,12.83,7.17,0,090,0.09,0.81,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,02642340,,Removal of salivary stone,A,,4.60,10.48,,3.99,,0.66,15.74,9.25,0,090,0.09,0.81,0.10,2,1,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,02742400,,Biopsy of salivary gland,A,,0.76,1.99,,0.59,,0.08,2.83,1.43,0,000,0.00,0.00,0.00,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,02842405,,Biopsy of salivary gland,A,,3.26,5.47,,2.33,,0.46,9.19,6.05,0,010,0.10,0.80,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,02942408,,Excision of salivary cyst,A,,4.54,11.88,,4.52,,0.65,17.07,9.71,0,090,0.09,0.81,0.10,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,03042409,,Drainage of salivary cyst,A,,2.84,8.33,,3.04,,0.42,11.59,6.30,0,090,0.09,0.81,0.10,2,0,2,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00