$536.42–$593.34
Choose 42409 when the operative service drains the cyst; choose 42408 when the cyst is excised.
On this page
CMS RVU26D · Effective 2026-10-01
42409 Salivary cyst drainage Medicare reimbursement rates in Pennsylvania
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 Pennsylvania.
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 Pennsylvania?
Pennsylvania has 2 payment localities in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the 2 payment areas shown below, using the same CMS release.
Office / nonfacility
$363.53–$402.94
2 of 2 localities have a supported rate.
Facility setting
$201.33–$219.00
2 of 2 localities have a supported rate.
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 Pennsylvania, from the same CMS release.
$88.93–$98.22
42400 describes needle sampling of a salivary gland. It is not the code for opening and draining a cyst.
$291.13–$319.37
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.
2 of 2 payment localities
Metropolitan Philadelphia →
Office / nonfacility
$402.94
Facility
$219.00
Rest Of Pennsylvania →
Office / nonfacility
$363.53
Facility
$201.33
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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