$87.24
Use 42405 for an incisional sample and 42400 when the salivary gland tissue is obtained by needle.
On this page
CMS RVU26D · Effective 2026-10-01
42405 Salivary gland biopsy Medicare reimbursement rates in Tennessee
Report this service when a surgeon obtains salivary gland tissue through an incision for diagnostic evaluation rather than sampling it with a needle. Compare 42405 office and facility rates across CMS payment localities in Tennessee.
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 42405 in Tennessee?
Tennessee 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
$283.21
1 of 1 localities have a supported rate.
Payment area: Tennessee
One mapped payment locality.
Facility setting
$187.88
1 of 1 localities have a supported rate.
Payment area: Tennessee
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.
Head and neck surgery
About 42405: Incisional salivary gland biopsy
Report this service when a surgeon obtains salivary gland tissue through an incision for diagnostic evaluation rather than sampling it with a needle.
This code describes an incisional biopsy that obtains salivary gland tissue for diagnosis. An otolaryngologist, head and neck surgeon, or oral and maxillofacial surgeon may perform it when a gland abnormality needs tissue evaluation, such as a persistent mass or unexplained enlargement. The surgeon exposes the selected gland tissue and removes a sample; the procedure may take place in an office or a facility, depending on the clinical situation and operative approach.
Choose this code for incisional tissue sampling, not needle sampling or definitive removal of a gland or lesion. The note should identify the gland and side, the reason for biopsy, the incisional approach, and the tissue obtained. Histologic examination is a separate service when performed and separately reportable. The code has a 10-day global period, so related postoperative visits during that period are included. When other procedures are performed 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 is restricted; co-surgeons and team surgery are not permitted.
CMS billing rules for 42405
- 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 RVU3.26 · 35%
- Practice expense (office) RVU5.47 · 60%
- Malpractice RVU0.46 · 5%
937
Medicare services in 2024 · #3019 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.
42405 compared with similar codes
Office rates for Tennessee, from the same CMS release.
Compare 42405 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
Tennessee →
Office / nonfacility
$283.21
Facility
$187.88
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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 42405 in Tennessee.
PPRRVU2026_Oct_nonQPP.csv
5,028
- Code
- 42405
- Physician work
- 3.26
- Practice expense
- 5.47
- Malpractice
- 0.46
GPCI2026.csv
95
- Locality
- Tennessee
- Physician work
- 1.000
- Practice expense
- 0.909
- Malpractice
- 0.537
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 3.26 | × 1.000 | 3.2600 |
| Practice expense | 5.47 | × 0.909 | 4.9722 |
| Malpractice | 0.46 | × 0.537 | 0.2470 |
| Total RVUs | 8.4793 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Tennessee$283.21
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 3.26 | 1 |
| Practice expense | 5.47 | 0.909 |
| Malpractice | 0.46 | 0.537 |
(3.26 × 1 + 5.47 × 0.909 + 0.46 × 0.537) × $33.4009 = $283.21
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 3.26 | 1 |
| Practice expense | 2.33 | 0.909 |
| Malpractice | 0.46 | 0.537 |
(3.26 × 1 + 2.33 × 0.909 + 0.46 × 0.537) × $33.4009 = $187.88
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.
42405 billing questions
How does 42405 differ from 42400?
42405 is for tissue obtained through an incision. 42400 is the needle-biopsy option; select the code that matches how the specimen was obtained.
Can the pathology examination be reported separately?
The biopsy code covers obtaining the specimen, not its microscopic evaluation. The pathology service may be reported separately when performed and otherwise reportable.
Can modifier 50 be used for biopsies on both sides?
No. CMS identifies bilateral adjustment as inappropriate for this code, so do not append modifier 50.
What postoperative care is included?
Related postoperative visits during the 10-day global period are included in the procedure payment.
How does the multiple-procedure rule affect payment?
When other procedures are performed in the same session, the highest-valued procedure is paid in full and the other procedures are subject to the standard 50% reduction.
May an assistant or co-surgeon be reported?
Assistant-at-surgery payment is restricted for this code. 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.
5,02542335,,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
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
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
9604412,TX,31,AUSTIN,1.002,1.058,0.886
9704412,TX,20,BEAUMONT,1.000,0.910,0.929
9804412,TX,09,BRAZORIA,1.008,0.991,0.780