Billing code 42409: Salivary cyst drainageMedicare rate & RVUs in Oklahoma
Report this service when a surgeon opens and drains a salivary cyst, such as a ranula, rather than removing the cyst.
Medicare pays $354.22 for 42409 in the office in Oklahoma (Oklahoma). 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 42409 covers
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.
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 in Oklahoma
| Payment locality | Office | Facility |
|---|---|---|
| Oklahoma | $354.22 | $196.43 |
How the 42409 rate is calculated
Each of 42409’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 · 42409
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 2.84Practice expense 8.33Malpractice 0.42
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 42409
42409 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 42409
Salivary cyst drainage
| 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) | 2 | Paid. |
| 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 · 42409
Salivary cyst drainage
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
42409 without 51 · national office
$387.12
Salivary cyst drainage
42409-51 · Second procedure: 50%
$193.56
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%).
42409 compared with similar codes
Compare codes
42409 vs 42408 vs 42400 vs 42405: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 42408Salivary cyst
- Choose 42409 when the operative service drains the cyst; choose 42408 when the cyst is excised.
- 42400Salivary biopsy
- 42400 describes needle sampling of a salivary gland. It is not the code for opening and draining a cyst.
- 42405Salivary gland biopsy
- 42405 describes incisional sampling of salivary gland tissue. Use 42409 when the documented treatment is cyst drainage rather than biopsy.
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 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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