$438.86
Both address sublingual or submandibular calculi, but 42330 is the intraoral approach and 42335 is the extraoral approach.
On this page
CMS RVU26D · Effective 2026-10-01
42330 Salivary stone removal Medicare reimbursement rates in Rhode Island
Reports intraoral incision and removal of a calculus from a sublingual or submandibular salivary duct when the stone requires surgical extraction. Compare 42330 office and facility rates across CMS payment localities in Rhode Island.
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 42330 in Rhode Island?
Rhode Island 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
$243.08
1 of 1 localities have a supported rate.
Payment area: Rhode Island
One mapped payment locality.
Facility setting
$152.68
1 of 1 localities have a supported rate.
Payment area: Rhode Island
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.
Otolaryngology procedure
About 42330: Intraoral submandibular salivary stone removal
Reports intraoral incision and removal of a calculus from a sublingual or submandibular salivary duct when the stone requires surgical extraction.
An otolaryngologist or oral and maxillofacial surgeon uses an incision inside the mouth to reach and extract a salivary calculus in the sublingual or submandibular duct region. A typical clinical situation is an obstructing duct stone causing meal-related gland swelling or recurrent symptoms when the stone cannot be removed by simpler means. The code distinguishes this intraoral approach from extraoral removal and from procedures directed at a parotid stone.
Select the code based on the documented stone site and surgical approach. The operative note should identify the affected duct or gland, the calculus, and the intraoral incision and extraction performed. Related postoperative visits during the 10-day global period are included. 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 multiple-procedure reduction. Modifier 50 is inappropriate. Medicare does not pay an assistant at surgery for this service; co-surgeons and team surgery are not permitted.
CMS billing rules for 42330
- Global period
- Minor procedure with a 10-day global period: related postoperative visits for 10 days 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
- Statutory restriction: assistant at surgery is not paid.
- Co-surgeons
- Co-surgeons not permitted.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU2.20 · 31%
- Practice expense (office) RVU4.59 · 64%
- Malpractice RVU0.33 · 5%
636
Medicare services in 2024 · #3346 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.
42330 compared with similar codes
Office rates for Rhode Island, from the same CMS release.
$537.82
Use 42340 for a parotid calculus removed extraorally; 42330 is for an intraoral procedure in the sublingual or submandibular region.
$187.31
42310 describes drainage of a sublingual or submandibular abscess through an intraoral approach. Use 42330 when the procedure removes a calculus rather than draining an abscess.
$267.42
42320 describes extraoral drainage of a sublingual or submandibular abscess; it is not the code for intraoral calculus extraction.
Compare 42330 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
Rhode Island →
Office / nonfacility
$243.08
Facility
$152.68
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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 42330 in Rhode Island.
PPRRVU2026_Oct_nonQPP.csv
5,024
- Code
- 42330
- Physician work
- 2.20
- Practice expense
- 4.59
- Malpractice
- 0.33
GPCI2026.csv
92
- Locality
- Rhode Island
- Physician work
- 1.019
- Practice expense
- 1.033
- Malpractice
- 0.892
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 2.20 | × 1.019 | 2.2418 |
| Practice expense | 4.59 | × 1.033 | 4.7415 |
| Malpractice | 0.33 | × 0.892 | 0.2944 |
| Total RVUs | 7.2776 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Rhode Island$243.08
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 2.2 | 1.019 |
| Practice expense | 4.59 | 1.033 |
| Malpractice | 0.33 | 0.892 |
(2.2 × 1.019 + 4.59 × 1.033 + 0.33 × 0.892) × $33.4009 = $243.08
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 2.2 | 1.019 |
| Practice expense | 1.97 | 1.033 |
| Malpractice | 0.33 | 0.892 |
(2.2 × 1.019 + 1.97 × 1.033 + 0.33 × 0.892) × $33.4009 = $152.68
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.
42330 billing questions
How does this differ from 42335?
This code describes an intraoral approach for a sublingual or submandibular calculus. Code 42335 is the extraoral approach for those gland regions.
When is 42340 more appropriate?
42340 is used for removal of a parotid calculus by an extraoral approach. Choose based on the documented gland and surgical route.
Can modifier 50 be reported for bilateral stones?
No. CMS identifies bilateral adjustment as inappropriate for this code; modifier 50 should not be used.
Are postoperative visits separately reported?
Related postoperative visits during the 10-day global period are included in the procedure.
How does Medicare handle other procedures performed in the same session?
The highest-valued procedure is paid in full, and other procedures are subject to the standard multiple-procedure reduction. An assistant at surgery is not paid, and co-surgeons and team surgery are not permitted.
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.
5,0214230F,,Anticonv thxpy for 6 mos/>,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
5,02242310,,Drainage of salivary gland,A,,1.57,3.69,,2.04,,0.22,5.48,3.83,0,010,0.10,0.80,0.10,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,02342320,,Drainage of salivary gland,A,,2.34,5.14,,2.16,,0.35,7.83,4.85,0,010,0.10,0.80,0.10,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,02442330,,Removal of salivary stone,A,,2.20,4.59,,1.97,,0.33,7.12,4.50,0,010,0.10,0.80,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,02542335,,Removal of salivary stone,A,,3.32,9.03,,3.37,,0.48,12.83,7.17,0,090,0.09,0.81,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,02642340,,Removal of salivary stone,A,,4.60,10.48,,3.99,,0.66,15.74,9.25,0,090,0.09,0.81,0.10,2,1,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
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
8912502,PA,01,METROPOLITAN PHILADELPHIA,1.018,1.041,1.193
9012502,PA,99,REST OF PENNSYLVANIA,1.000,0.918,0.945
9109202,PR,20,PUERTO RICO,1.000,1.011,0.985
9214412,RI,01,RHODE ISLAND,1.019,1.033,0.892
9311202,SC,01,SOUTH CAROLINA,1.000,0.924,0.850
9403402,SD,02,SOUTH DAKOTA**,1.000,1.000,0.336
9510312,TN,35,TENNESSEE,1.000,0.909,0.537