Billing code 42810: Neck cyst excisionMedicare rate & RVUs in Oregon
Reports removal of a superficial branchial cleft cyst or remnant confined to the skin and subcutaneous tissue, without deeper extension.
Medicare pays $380.41–$412.74 for 42810 in the office in Oregon, from Rest Of Oregon to Portland. 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 42810 covers
This code describes surgical removal of a branchial cleft cyst or remnant when it is limited to the skin and tissue just beneath it. Otolaryngologists and other surgeons may perform the procedure for a congenital neck lump or draining opening attributable to a superficial branchial cleft remnant. The operative report should identify the lesion and its location and show that its extent remained within the skin and subcutaneous tissues.
Choose this code based on the documented depth and extent, not simply the diagnosis of a neck cyst. A remnant extending deeper than the subcutaneous tissues or into the pharynx points to 42815 instead. The procedure has a 90-day global period, including the day-before preoperative visit and related postoperative care during that period. When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% reduction. For bilateral procedures, modifier 50 is paid at 150%. Assistant-at-surgery payment may be available; 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.
Where 42810 pays more and less in Oregon
| Payment locality | Office | Facility |
|---|---|---|
| Portland | $412.74 | $270.24 |
| Rest Of Oregon | $380.41 | $252.66 |
How the 42810 rate is calculated
Each of 42810’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 · 42810
RVUs × geographic indexes × conversion factor
Work3.30
3.30 RVUs× 1.000 GPCI
Practice expense7.79
7.79 RVUs× 1.000 GPCI
Malpractice0.47
0.47 RVUs× 1.000 GPCI
Adjusted RVUs
11.5600
Conversion factor
$33.4009
Medicare rate
$386.11
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 42810
42810 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 42810
Neck cyst excision
| 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) | 1 | Bilateral with modifier 50 pays 150% of the fee schedule amount. |
| 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 · 42810
Neck cyst excision
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 50 · payment effect
With and without the modifier
42810 without 50 · national office
$386.11
Neck cyst excision
42810-50 · Bilateral: 150%
$579.17
Both sides on one line with modifier 50 are paid at 150% of the fee schedule amount (subject to multiple-procedure rules with other procedures).
42810 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 42815Neck cyst excision
- Both address branchial cleft cysts or remnants, but 42810 is limited to lesions within skin and subcutaneous tissue. Deeper extension or extension into the pharynx is the distinguishing feature for 42815.
- 60281Duct lesion excision
- Use 60281 for a primary thyroglossal duct cyst or sinus. A branchial cleft cyst or remnant confined to skin and subcutaneous tissue is reported with 42810.
- 21555Mass excision
- This code is for a qualifying soft-tissue mass of the neck, not a branchial cleft remnant. The documented diagnosis and operative findings determine which service applies.
42810 billing questions
How do I distinguish 42810 from 42815?
Use 42810 when the branchial cleft cyst or remnant is confined to skin and subcutaneous tissue. Use 42815 when the operative documentation describes extension beneath the subcutaneous tissues or into the pharynx.
What documentation supports 42810?
Document the branchial cleft origin, neck location, and operative findings showing the lesion remained within skin and subcutaneous tissue. The depth and extent of the excision distinguish this code from 42815.
What postoperative care is included?
The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.
How is 42810 handled with another procedure 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%.
Can modifier 50 be used for bilateral excision?
The CMS bilateral rule specifies modifier 50, with payment at 150% for a bilateral procedure.
Can an assistant or co-surgeon be reported?
Assistant-at-surgery payment may be available. Co-surgeons and team surgery are not permitted 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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