$424.34
42500 describes suturing a salivary duct. Choose 42600 when the operative target is closure of an abnormal salivary fistula.
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CMS RVU26D · Effective 2026-10-01
42600 Fistula closure Medicare reimbursement rates in Ohio
Surgical closure of an abnormal salivary tract, such as persistent leakage from a salivary gland or duct to the skin or oral surface. Compare 42600 office and facility rates across CMS payment localities in Ohio.
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 42600 in Ohio?
Ohio 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
$508.72
1 of 1 localities have a supported rate.
Payment area: Ohio
One mapped payment locality.
Facility setting
$307.76
1 of 1 localities have a supported rate.
Payment area: Ohio
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 42600: Surgical closure of salivary fistula
Surgical closure of an abnormal salivary tract, such as persistent leakage from a salivary gland or duct to the skin or oral surface.
This operation closes an abnormal tract through which saliva escapes from a salivary gland or duct, such as a persistent opening from a parotid-region fistula to the skin. An otolaryngologist, head and neck surgeon, or oral and maxillofacial surgeon may perform the repair, typically in an operating room. The surgeon identifies the fistulous tract and surgically closes it; this is distinct from simply dilating or ligating a salivary duct.
Report 42600 when the operative service is closure of the salivary fistula. The operative report should identify the fistula’s location and salivary source, describe the closure performed, and distinguish it from a duct repair or ligation. CMS assigns a 90-day global period, including the day-before preoperative visit and related postoperative care. When multiple procedures occur 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 requires documented medical necessity; co-surgeons and team surgery are not permitted.
CMS billing rules for 42600
- 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 is paid only with documentation of medical necessity.
- Co-surgeons
- Co-surgeons not permitted.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU4.82 · 30%
- Practice expense (office) RVU10.63 · 66%
- Malpractice RVU0.70 · 4%
15
Medicare services in 2024 · #6072 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.
42600 compared with similar codes
Office rates for Ohio, from the same CMS release.
$544.97
42505 is for repair of the salivary duct itself; 42600 is for surgically closing a fistulous tract.
$345.00
42665 describes salivary duct ligation. It differs from 42600, which closes the fistula rather than ligating the duct.
$72.67
42650 describes dilation of a salivary duct, not closure of a salivary fistula.
Compare 42600 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
Ohio →
Office / nonfacility
$508.72
Facility
$307.76
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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 42600 in Ohio.
PPRRVU2026_Oct_nonQPP.csv
5,051
- Code
- 42600
- Physician work
- 4.82
- Practice expense
- 10.63
- Malpractice
- 0.70
GPCI2026.csv
85
- Locality
- Ohio
- Physician work
- 1.000
- Practice expense
- 0.913
- Malpractice
- 1.008
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 4.82 | × 1.000 | 4.8200 |
| Practice expense | 10.63 | × 0.913 | 9.7052 |
| Malpractice | 0.70 | × 1.008 | 0.7056 |
| Total RVUs | 15.2308 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Ohio$508.72
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 4.82 | 1 |
| Practice expense | 10.63 | 0.913 |
| Malpractice | 0.7 | 1.008 |
(4.82 × 1 + 10.63 × 0.913 + 0.7 × 1.008) × $33.4009 = $508.72
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 4.82 | 1 |
| Practice expense | 4.04 | 0.913 |
| Malpractice | 0.7 | 1.008 |
(4.82 × 1 + 4.04 × 0.913 + 0.7 × 1.008) × $33.4009 = $307.76
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.
42600 billing questions
How is fistula closure different from salivary duct repair?
Use 42600 when the procedure closes an abnormal tract leaking saliva. Codes for duct repair describe repair of the duct itself, rather than closure of a fistula.
Is modifier 50 appropriate for bilateral fistula closure?
No. CMS identifies bilateral adjustment as inappropriate for this code.
What postoperative care is included?
The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.
When may an assistant-at-surgery be paid?
Payment is allowed only when the record documents medical necessity for the assistant.
Can co-surgeons or a surgical team be reported?
CMS does not permit co-surgeon or team-surgery payment for this code.
How is 42600 affected when other procedures are performed in the same session?
Under the standard multiple-procedure reduction, the highest-valued procedure is paid in full and the other procedures are paid 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.
5,04842550,,Injection for salivary x-ray,A,,1.22,3.06,,0.22,,0.12,4.40,1.56,0,000,0.00,0.00,0.00,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,0494255F,,Anesth 60 min/> as docd,M,,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
5,0504256F,,Anesthe <60 min as docd,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
5,05142600,,Closure of salivary fistula,A,,4.82,10.63,,4.04,,0.70,16.15,9.56,0,090,0.09,0.81,0.10,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,0524260F,,Wound srfc culturetech used,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
5,0534261F,,Tech other than surfc cultr,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
5,05442650,,Dilation of salivary duct,A,,0.75,1.44,,0.74,,0.11,2.30,1.60,0,000,0.00,0.00,0.00,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
8213282,NY,99,REST OF NEW YORK,1.000,0.950,0.703
8311502,NC,00,NORTH CAROLINA,1.000,0.933,0.639
8403302,ND,01,NORTH DAKOTA**,1.000,1.000,0.406
8515202,OH,00,OHIO,1.000,0.913,1.008
8604312,OK,00,OKLAHOMA,1.000,0.893,0.777
8702302,OR,01,PORTLAND,1.016,1.111,0.744
8802302,OR,99,REST OF OREGON,1.000,0.996,0.703