$368.99
42408 is for excision of the cyst; 42409 describes drainage. Select according to the procedure actually performed.
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CMS RVU26D · Effective 2026-10-01
42408 Salivary cyst Medicare reimbursement rates in Utah
Report this service when a surgeon removes a salivary cyst, such as a ranula, rather than draining it or taking a diagnostic sample. Compare 42408 office and facility rates across CMS payment localities in Utah.
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 42408 in Utah?
Utah 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
$544.13
1 of 1 localities have a supported rate.
Payment area: Utah
One mapped payment locality.
Facility setting
$313.05
1 of 1 localities have a supported rate.
Payment area: Utah
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.
Salivary gland surgery
About 42408: Excision of salivary cyst
Report this service when a surgeon removes a salivary cyst, such as a ranula, rather than draining it or taking a diagnostic sample.
CPT 42408 represents surgical removal of a cyst arising from salivary tissue. A typical presentation is a persistent or recurrent fluid-filled lesion in the floor of the mouth, such as a ranula. Otolaryngologists and oral and maxillofacial surgeons commonly perform the procedure in an operating room or another setting suited to the lesion and anesthesia. The operative note should identify the cyst’s location and approach, describe what was removed, and state whether tissue was sent for pathology.
Report 42408 for excision; opening the cyst to release its contents is represented by 42409, while a biopsy code describes sampling. Document the diagnosis, operative findings, and excision performed. CMS assigns a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. When multiple procedures are performed in one session, the highest-valued procedure is paid in full and others are subject to the standard 50% reduction. Modifier 50 is inappropriate for this code. Assistant-at-surgery payment requires documented medical necessity; co-surgeons and team surgery are not permitted.
CMS billing rules for 42408
- 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 is paid only with documentation of medical necessity.
- Co-surgeons
- Co-surgeons not permitted.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU4.54 · 27%
- Practice expense (office) RVU11.88 · 70%
- Malpractice RVU0.65 · 4%
52
Medicare services in 2024 · #5330 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.
42408 compared with similar codes
Office rates for Utah, from the same CMS release.
$90.26
42400 represents salivary gland biopsy. It is for tissue sampling, not definitive excision of a salivary cyst.
$294.42
42405 is also a salivary gland biopsy code. Use 42408 when the operative service removes the cyst rather than sampling it.
No office rate
42410 concerns excision involving the parotid gland or a parotid lesion. 42408 is for excision of a salivary cyst.
Compare 42408 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
Utah →
Office / nonfacility
$544.13
Facility
$313.05
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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 42408 in Utah.
PPRRVU2026_Oct_nonQPP.csv
5,029
- Code
- 42408
- Physician work
- 4.54
- Practice expense
- 11.88
- Malpractice
- 0.65
GPCI2026.csv
104
- Locality
- Utah
- Physician work
- 1.000
- Practice expense
- 0.940
- Malpractice
- 0.898
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 4.54 | × 1.000 | 4.5400 |
| Practice expense | 11.88 | × 0.940 | 11.1672 |
| Malpractice | 0.65 | × 0.898 | 0.5837 |
| Total RVUs | 16.2909 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Utah$544.13
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 4.54 | 1 |
| Practice expense | 11.88 | 0.94 |
| Malpractice | 0.65 | 0.898 |
(4.54 × 1 + 11.88 × 0.94 + 0.65 × 0.898) × $33.4009 = $544.13
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 4.54 | 1 |
| Practice expense | 4.52 | 0.94 |
| Malpractice | 0.65 | 0.898 |
(4.54 × 1 + 4.52 × 0.94 + 0.65 × 0.898) × $33.4009 = $313.05
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.
42408 billing questions
When should 42408 be chosen over 42409?
Use 42408 when the surgeon removes the salivary cyst. Use 42409 when the documented procedure drains the cyst rather than excising it.
Can a biopsy code be reported for the same cyst?
A biopsy code describes diagnostic tissue sampling, not removal of the cyst. The operative documentation should establish whether the surgeon sampled tissue or excised the cyst.
Can modifier 50 be used for bilateral cyst excision?
No. CMS identifies bilateral adjustment as inappropriate for 42408, so modifier 50 should not be used.
What postoperative care is included?
The 90-day global period includes the preoperative visit on the day before surgery and 90 days of related postoperative care.
How is 42408 affected when other procedures occur in the same session?
CMS applies the standard multiple-procedure reduction: the highest-valued procedure is paid in full, and other procedures are subject to a 50% reduction.
What documentation supports assistant-at-surgery payment?
The record must document the medical necessity of the assistant. CMS does not permit co-surgeon or team-surgery payment 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.
5,02642340,,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
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
10104412,TX,15,GALVESTON,1.008,0.993,0.828
10204412,TX,18,HOUSTON,1.008,0.993,1.376
10304412,TX,99,REST OF TEXAS,1.000,0.949,0.903
10403502,UT,09,UTAH,1.000,0.940,0.898
10514512,VT,50,VERMONT,1.000,0.990,0.506
10611302,VA,00,VIRGINIA,1.000,0.983,0.706
10709202,VI,50,VIRGIN ISLANDS,1.000,1.011,0.985