CPT code 42335: Stone removal2026 Medicare rate & RVUs in Massachusetts
Reports complicated removal of a salivary duct stone through an intraoral approach, such as when routine extraction requires more extensive operative work.
Medicare pays $443.04–$489.83 for 42335 in the office in Massachusetts, from Rest Of Massachusetts to Metropolitan Boston. 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 42335 covers
This service involves operative removal of a salivary calculus through the mouth when the extraction is documented as complicated. An otolaryngologist or oral and maxillofacial surgeon may perform it for an obstructing stone in an accessible salivary duct, commonly involving the submandibular or sublingual system. The work may include exposing the duct, making an incision, and extracting the stone; the operative report should identify the gland or duct, intraoral route, and specific factors that made the removal complicated.
Choose this code rather than the uncomplicated removal code when the documented procedure meets the complicated intraoral level. The record should support the approach, operative extent, and stone removal, not merely the diagnosis of sialolithiasis. Medicare treats the service as major surgery with a 90-day global period, including the day-before preoperative visit and related postoperative care during that period. When multiple procedures are performed in one session, the highest-valued is paid in full and other procedures are subject to the standard multiple procedure reduction. Modifier 50 is inappropriate; assistant-at-surgery payment is statutorily restricted, and co-surgeon and team-surgery payment 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.
Where 42335 pays more and less in Massachusetts
| Payment locality | Office | Facility |
|---|---|---|
| Metropolitan Boston | $489.83 | $264.10 |
| Rest Of Massachusetts | $443.04 | $243.97 |
How the 42335 rate is calculated
Each of 42335’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 · 42335
RVUs × geographic indexes × conversion factor
Work3.32
3.32 RVUs× 1.000 GPCI
Practice expense9.03
9.03 RVUs× 1.000 GPCI
Malpractice0.48
0.48 RVUs× 1.000 GPCI
Adjusted RVUs
12.8300
Conversion factor
$33.4009
Medicare rate
$428.53
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 42335
42335 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 42335
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) | 0 | The 150% bilateral adjustment doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 1 | Not paid (statutory restriction). |
| 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 · 42335
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 51 · payment effect
With and without the modifier
42335 without 51 · national office
$428.53
Stone removal
42335-51 · Second procedure: 50%
$214.27
When this isn’t the highest-valued procedure in the session, Medicare pays 50% of its fee schedule amount (the highest is paid at 100%).
42335 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 42330Salivary stone removal
- This code is for the complicated intraoral level. 42330 is the uncomplicated salivary stone removal level.
- 42340Stone removal
- Both describe complicated salivary stone removal, but 42340 is used for an extraoral approach rather than an intraoral one.
- 42310Salivary drainage
- 42310 describes drainage of a sublingual or submandibular abscess through an intraoral approach; 42335 is for removal of a salivary stone.
- 42320Abscess drainage
- 42320 describes extraoral drainage of a sublingual or submandibular abscess, not intraoral stone removal.
42335 billing questions
How does this differ from 42330?
42335 is for a complicated removal by an intraoral approach. 42330 represents the uncomplicated level; the operative documentation should support the level selected.
When would 42340 be more appropriate?
42340 is the complicated removal code for an extraoral approach. Use 42335 when the documented operative route is through the mouth.
What should the operative report document?
Document the salivary gland or duct, intraoral approach, stone extraction, and the operative details supporting the complicated level.
Can modifier 50 be used for stones on both sides?
No. CMS identifies bilateral adjustment as inappropriate for this code. Modifier 50 should not be used.
How does the global period affect postoperative billing?
The 90-day global period includes the day-before preoperative visit and related postoperative care. Those included services are part of the surgical global period.
Can an assistant or co-surgeon be paid for this procedure?
CMS lists a statutory restriction on assistant-at-surgery payment for this code. 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 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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