Billing code 42500: Duct repairMedicare rate & RVUs in Texas
Repair of an injured or disrupted salivary duct, reported when the surgeon restores duct continuity rather than creating a diversion.
Medicare pays $421.86–$463.32 for 42500 in the office in Texas, from Beaumont to Austin. 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 42500 covers
The surgeon repairs a damaged salivary duct to restore the flow of saliva, such as after a duct injury near the cheek or inside the mouth. Otolaryngologists, oral and maxillofacial surgeons, and other surgeons familiar with salivary duct anatomy may perform the repair, commonly in an operating room. The operative report should identify the duct and describe the injury and repair performed.
Report this code for the duct repair itself, not for a procedure that redirects the duct to a different opening. The record should support the need for repair and the work performed. This major surgery code includes 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 other procedures are subject to the standard 50% multiple procedure reduction. Modifier 50 is inappropriate for this code. An assistant at surgery is paid only when medical necessity is documented; 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 42500 pays more and less in Texas
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
8 payment localities
$421.86 to $463.32
8 of 8 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Austin | $463.32 | $319.85 |
| Beaumont | $421.86 | $298.45 |
| Brazoria | $442.95 | $308.56 |
| Dallas | $446.13 | $311.06 |
| Fort Worth | $443.55 | $309.84 |
| Galveston | $444.51 | $309.85 |
| Houston | $455.86 | $321.20 |
| Rest Of Texas | $432.40 | $303.71 |
How the 42500 rate is calculated
Each of 42500’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 · 42500
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 4.31Practice expense 8.51Malpractice 0.62
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 42500
42500 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 42500
Duct repair
| 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) | 0 | Not paid without supporting documentation. |
| 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 · 42500
Duct repair
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
42500 without 51 · national office
$448.91
Duct repair
42500-51 · Second procedure: 50%
$224.46
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%).
42500 compared with similar codes
Compare codes
42500 vs 42505 vs 42507 vs 42509: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 42505Salivary duct repair
- Both codes concern salivary duct repair. Choose based on the specific repair performed and the applicable code descriptor, rather than treating the codes as interchangeable.
- 42507Parotid duct diversion
- This code is for duct diversion, which redirects salivary flow. Use 42500 when the surgeon repairs the duct itself.
- 42509Parotid duct diversion
- This is a diversion procedure, not a repair. The operative report should show whether the duct was redirected or restored.
42500 billing questions
How is duct repair different from parotid duct diversion?
Repair restores an injured or disrupted duct. Diversion redirects the duct to a different opening, so select the code that matches the operation documented.
What documentation supports this code?
Document the affected duct, the injury or defect, and the steps taken to restore duct continuity. The operative note should distinguish repair from redirection.
Can modifier 50 be reported?
No. Modifier 50 is inappropriate for this code based on its descriptor and anatomy.
What postoperative care is included?
The major-surgery global period includes the day-before preoperative visit and 90 days of related postoperative care.
Can an assistant surgeon or co-surgeon be reported?
Assistant-at-surgery payment requires documentation of medical necessity. 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
Fee sheets
Put 42500 and the rest of your codes on one sheet
Build a fee sheet from your own code list at your locality, put your payer contracts beside Medicare, and see what changed each quarter.
Build my fee sheetOr price your code list free →