$383.75
42810 is the more limited branchial cleft cyst, remnant, or fistula excision. Choose 42815 when the documented lesion extends below the hyoid.
On this page
CMS RVU26D · Effective 2026-10-01
42815 Neck cyst excision Medicare reimbursement rates in Nevada
Reports surgical removal of a branchial cleft cyst, remnant, or fistula that extends below the hyoid, typically during facility-based head and neck surgery. Compare 42815 office and facility rates across CMS payment localities in Nevada.
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 42815 in Nevada?
Nevada 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
No supported rate
Facility setting
$472.65
1 of 1 localities have a supported rate.
Payment area: Nevada**
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.
Head and neck surgery
About 42815: Deep Branchial Cleft Cyst Excision
Reports surgical removal of a branchial cleft cyst, remnant, or fistula that extends below the hyoid, typically during facility-based head and neck surgery.
An otolaryngologist or head and neck surgeon uses this code for removal of a branchial cleft cyst, vestige, or fistulous tract that extends below the hyoid bone. The operation may involve tracing and removing the tract through deeper neck tissues; the excised tissue is typically submitted for pathologic examination. These cases are commonly performed in an operating room rather than an office setting.
Choose this code when the operative findings and procedure document extension below the hyoid, distinguishing it from the more limited excision reported with 42810. The operative report should identify the lesion or tract, its extent, the dissection performed, and whether the procedure was unilateral or bilateral. A 90-day global period includes the day-before preoperative visit and related postoperative care. For multiple procedures in one session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% reduction. Bilateral reporting with modifier 50 is paid at 150%. Assistant-at-surgery payment may be available; co-surgeons require supporting documentation, and team surgery is not permitted.
CMS billing rules for 42815
- 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 procedure with modifier 50 is paid at 150%.
- Assistant at surgery
- Assistant at surgery may be paid.
- Co-surgeons
- Co-surgeons paid only with supporting documentation.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU7.13 · 50%
- Practice expense (office) RVU6.14 · 43%
- Malpractice RVU1.05 · 7%
85
Medicare services in 2024 · #4999 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.
42815 compared with similar codes
Office rates for Nevada, from the same CMS release.
No office rate
60280 is used for a thyroglossal duct cyst or sinus. A branchial cleft cyst, vestige, or fistula extending below the hyoid is reported with 42815.
$458.33
21555 describes excision of a subcutaneous neck soft-tissue tumor. It is not the code for removal of a branchial cleft cyst or tract.
No office rate
21556 describes excision of a deep neck soft-tissue tumor. Use 42815 when the documented lesion is a branchial cleft cyst, vestige, or fistula extending below the hyoid.
Compare 42815 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
Nevada** →
Office / nonfacility
Unavailable
Facility
$472.65
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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 42815 in Nevada**.
PPRRVU2026_Oct_nonQPP.csv
5,078
- Code
- 42815
- Physician work
- 7.13
- Practice expense
- 6.14
- Malpractice
- 1.05
GPCI2026.csv
73
- Locality
- Nevada**
- Physician work
- 1.000
- Practice expense
- 1.001
- Malpractice
- 0.833
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 7.13 | × 1.000 | 7.1300 |
| Practice expense | 6.14 | × 1.001 | 6.1461 |
| Malpractice | 1.05 | × 0.833 | 0.8747 |
| Total RVUs | 14.1508 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Nevada**$472.65
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 7.13 | 1 |
| Practice expense | 6.14 | 1.001 |
| Malpractice | 1.05 | 0.833 |
(7.13 × 1 + 6.14 × 1.001 + 1.05 × 0.833) × $33.4009 = $472.65
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.
42815 billing questions
How does 42815 differ from 42810?
Use 42815 when the branchial cleft cyst, remnant, or fistula extends below the hyoid. Code 42810 describes the more limited excision.
What operative documentation supports 42815?
Document the lesion or tract, its anatomic extent below the hyoid, and the dissection and removal performed. State whether the procedure was unilateral or bilateral.
Does the 90-day global include postoperative visits?
It includes related postoperative care for 90 days, as well as the day-before preoperative visit.
How is bilateral excision reported?
When the procedure is performed bilaterally, report modifier 50; CMS pays the bilateral procedure at 150%.
Can an assistant or co-surgeon be reported?
Assistant-at-surgery payment may be available. Co-surgeons are paid only with supporting documentation, and team surgery is not permitted.
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, with payment at 50%.
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.
5,07542809,,Remove pharynx foreign body,A,,1.81,4.33,,1.41,,0.28,6.42,3.50,0,010,0.10,0.80,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,0764280F,,Pcp prophylax rxd 3mon low %,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
5,07742810,,Excision of neck cyst,A,,3.30,7.79,,3.95,,0.47,11.56,7.72,0,090,0.09,0.81,0.10,2,1,2,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,07842815,,Excision of neck cyst,A,,7.13,6.14,NA,6.14,,1.05,14.32,14.32,0,090,0.09,0.81,0.10,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,07942820,,Remove tonsils and adenoids,A,,4.11,3.11,NA,3.11,,0.59,7.81,7.81,0,090,0.09,0.81,0.10,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,08042821,,Remove tonsils and adenoids,A,,4.25,3.29,NA,3.29,,0.61,8.15,8.15,0,090,0.09,0.81,0.10,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,08142825,,Removal of tonsils,A,,3.42,3.39,NA,3.39,,0.48,7.29,7.29,0,090,0.09,0.81,0.10,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7005302,MO,99,REST OF MISSOURI,1.000,0.862,0.974
7103202,MT,01,MONTANA**,1.000,1.000,0.998
7205402,NE,00,NEBRASKA,1.000,0.923,0.378
7301312,NV,00,NEVADA**,1.000,1.001,0.833
7414312,NH,40,NEW HAMPSHIRE,1.000,1.041,0.875
7512402,NJ,01,NORTHERN NJ,1.063,1.160,1.068
7612402,NJ,99,REST OF NEW JERSEY,1.040,1.092,1.097