Billing code 42405: Salivary gland biopsyMedicare rate & RVUs in Nebraska
Report this service when a surgeon obtains salivary gland tissue through an incision for diagnostic evaluation rather than sampling it with a needle.
Medicare pays $283.33 for 42405 in the office in Nebraska (Nebraska). 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 42405 covers
This code describes an incisional biopsy that obtains salivary gland tissue for diagnosis. An otolaryngologist, head and neck surgeon, or oral and maxillofacial surgeon may perform it when a gland abnormality needs tissue evaluation, such as a persistent mass or unexplained enlargement. The surgeon exposes the selected gland tissue and removes a sample; the procedure may take place in an office or a facility, depending on the clinical situation and operative approach.
Choose this code for incisional tissue sampling, not needle sampling or definitive removal of a gland or lesion. The note should identify the gland and side, the reason for biopsy, the incisional approach, and the tissue obtained. Histologic examination is a separate service when performed and separately reportable. The code has a 10-day global period, so related postoperative visits during that period are included. 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. Modifier 50 is inappropriate. Assistant-at-surgery payment is restricted; co-surgeons and team surgery 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.
42405 in Nebraska
| Payment locality | Office | Facility |
|---|---|---|
| Nebraska | $283.33 | $186.53 |
How the 42405 rate is calculated
Each of 42405’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 · 42405
RVUs × geographic indexes × conversion factor
Work3.26
3.26 RVUs× 1.000 GPCI
Practice expense5.47
5.47 RVUs× 1.000 GPCI
Malpractice0.46
0.46 RVUs× 1.000 GPCI
Adjusted RVUs
9.1900
Conversion factor
$33.4009
Medicare rate
$306.95
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 42405
42405 has a 10-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 42405
Salivary gland biopsy
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 010 | Minor procedure: the day of the procedure plus 10 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) | 0.10/0.80/0.10 | Share of the payment for pre-op, the procedure itself, and post-op care. |
Global surgery period · 42405
Salivary gland biopsy
10-day global period ends
Oct 11, 2026
Covers Oct 1, 2026 through Oct 11, 2026 (11 days).
Visit on Oct 31, 2026
After the global period ends: visits and procedures are billed normally.
What modifiers do to the payment
Modifier 51 · payment effect
With and without the modifier
42405 without 51 · national office
$306.95
Salivary gland biopsy
42405-51 · Second procedure: 50%
$153.48
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%).
42405 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 42400Salivary biopsy
- Use 42405 for an incisional sample and 42400 when the salivary gland tissue is obtained by needle.
- 42410Parotid excision
- 42405 obtains tissue for diagnosis; 42410 describes excision of a parotid gland or lesion.
- 42440Salivary gland excision
- 42405 samples gland tissue; 42440 is for excision of the submaxillary gland.
42405 billing questions
How does 42405 differ from 42400?
42405 is for tissue obtained through an incision. 42400 is the needle-biopsy option; select the code that matches how the specimen was obtained.
Can the pathology examination be reported separately?
The biopsy code covers obtaining the specimen, not its microscopic evaluation. The pathology service may be reported separately when performed and otherwise reportable.
Can modifier 50 be used for biopsies on both sides?
No. CMS identifies bilateral adjustment as inappropriate for this code, so do not append modifier 50.
What postoperative care is included?
Related postoperative visits during the 10-day global period are included in the procedure payment.
How does the multiple-procedure rule affect payment?
When other procedures are performed in the same session, the highest-valued procedure is paid in full and the other procedures are subject to the standard 50% reduction.
May an assistant or co-surgeon be reported?
Assistant-at-surgery payment is restricted 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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