$541.58
Choose 42409 when the operative service drains the cyst; choose 42408 when the cyst is excised.
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CMS RVU26D · Effective 2026-10-01
42409 Salivary cyst drainage Medicare reimbursement rates in New Mexico
Report this service when a surgeon opens and drains a salivary cyst, such as a ranula, rather than removing the cyst. Compare 42409 office and facility rates across CMS payment localities in New Mexico.
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 42409 in New Mexico?
New Mexico 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
$366.84
1 of 1 localities have a supported rate.
Payment area: New Mexico
One mapped payment locality.
Facility setting
$204.82
1 of 1 localities have a supported rate.
Payment area: New Mexico
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 42409: Drainage of a salivary cyst
Report this service when a surgeon opens and drains a salivary cyst, such as a ranula, rather than removing the cyst.
An otolaryngologist or oral and maxillofacial surgeon may open a fluid-filled salivary cyst to decompress it and allow its contents to drain. A ranula arising in the floor of the mouth is a familiar clinical example. The service addresses drainage of the cyst; it is distinct from removing the cyst or excising a salivary gland. It may be performed in an operating room or another surgical setting, depending on the case.
Select this code when the operative record supports drainage rather than excision. Document the cyst’s location and the drainage performed; do not choose it solely because a salivary lesion was treated. CMS assigns a 90-day major-surgery global period, including the day-before preoperative visit and 90 days of related postoperative care. When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and the others are subject to the standard multiple-procedure reduction. An assistant at surgery may be paid. Modifier 50 is inappropriate; co-surgeons and team surgery are not permitted.
CMS billing rules for 42409
- 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 may be paid.
- Co-surgeons
- Co-surgeons not permitted.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU2.84 · 25%
- Practice expense (office) RVU8.33 · 72%
- Malpractice RVU0.42 · 4%
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.
42409 compared with similar codes
Office rates for New Mexico, from the same CMS release.
$89.54
42400 describes needle sampling of a salivary gland. It is not the code for opening and draining a cyst.
$294.88
42405 describes incisional sampling of salivary gland tissue. Use 42409 when the documented treatment is cyst drainage rather than biopsy.
Compare 42409 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
New Mexico →
Office / nonfacility
$366.84
Facility
$204.82
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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 42409 in New Mexico.
PPRRVU2026_Oct_nonQPP.csv
5,030
- Code
- 42409
- Physician work
- 2.84
- Practice expense
- 8.33
- Malpractice
- 0.42
GPCI2026.csv
77
- Locality
- New Mexico
- Physician work
- 1.000
- Practice expense
- 0.917
- Malpractice
- 1.201
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 2.84 | × 1.000 | 2.8400 |
| Practice expense | 8.33 | × 0.917 | 7.6386 |
| Malpractice | 0.42 | × 1.201 | 0.5044 |
| Total RVUs | 10.9830 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, New Mexico$366.84
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 2.84 | 1 |
| Practice expense | 8.33 | 0.917 |
| Malpractice | 0.42 | 1.201 |
(2.84 × 1 + 8.33 × 0.917 + 0.42 × 1.201) × $33.4009 = $366.84
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 2.84 | 1 |
| Practice expense | 3.04 | 0.917 |
| Malpractice | 0.42 | 1.201 |
(2.84 × 1 + 3.04 × 0.917 + 0.42 × 1.201) × $33.4009 = $204.82
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.
42409 billing questions
How do I distinguish drainage from excision of a salivary cyst?
Use drainage when the surgeon opens the cyst to release its contents. Use 42408 when the cyst itself is removed.
Can a ranula be reported with this code?
A ranula in the floor of the mouth is a typical salivary cyst example when the documented procedure is drainage rather than removal.
What documentation supports this code?
The operative note should identify the cyst and its location and describe opening it and draining its contents. A diagnosis of a salivary lesion alone does not establish that drainage was performed.
Does this code have a global period?
Yes. CMS assigns a 90-day major-surgery global period, which includes the day-before preoperative visit and 90 days of related postoperative care.
Can modifier 50 be used for bilateral drainage?
No. CMS identifies modifier 50 as inappropriate for this code.
Can an assistant or co-surgeon be reported?
An assistant at surgery may be paid. Co-surgeons and team surgery are not permitted under the CMS rules for this code.
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.
5,02742400,,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
5,0314240F,,Instr xrcz back pain 12 wks,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
5,03242410,,Excise parotid gland/lesion,A,,9.33,5.90,NA,5.90,,1.45,16.68,16.68,0,090,0.09,0.81,0.10,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,03342415,,Excise parotid gland/lesion,A,,16.73,8.31,NA,8.31,,2.51,27.55,27.55,0,090,0.09,0.81,0.10,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
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
7704212,NM,05,NEW MEXICO,1.000,0.917,1.201
7813202,NY,01,MANHATTAN,1.064,1.162,1.586
7913202,NY,02,NYC SUBURBS/LONG ISLAND,1.064,1.189,1.857
8013202,NY,03,POUGHKPSIE/N NYC SUBURBS,1.045,1.095,1.210