CPT code 42815: Neck cyst excision2026 Medicare rate & RVUs in Virginia
Reports surgical removal of a branchial cleft cyst, remnant, or fistula that extends below the hyoid, typically during facility-based head and neck surgery.
CMS doesn’t publish an office rate for 42815 in Virginia.
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 42815 covers
An otolaryngologist or head and neck surgeon uses this code for removal of a branchial cleft cyst, vestige, or fistulous tract that extends below the hyoid bone. The operation may involve tracing and removing the tract through deeper neck tissues; the excised tissue is typically submitted for pathologic examination. These cases are commonly performed in an operating room rather than an office setting.
Choose this code when the operative findings and procedure document extension below the hyoid, distinguishing it from the more limited excision reported with 42810. The operative report should identify the lesion or tract, its extent, the dissection performed, and whether the procedure was unilateral or bilateral. A 90-day global period includes the day-before preoperative visit and related postoperative care. For multiple procedures in one session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% reduction. Bilateral reporting with modifier 50 is paid at 150%. Assistant-at-surgery payment may be available; co-surgeons require supporting documentation, and team surgery is 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 42815 pays more and less in Virginia
| Payment locality | Office | Facility |
|---|---|---|
| Dc + Md/Va Suburbs | Unavailable | $531.63 |
| Virginia | Unavailable | $464.50 |
How the 42815 rate is calculated
Each of 42815’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 · 42815
RVUs × geographic indexes × conversion factor
Work7.13
7.13 RVUs× 1.000 GPCI
Practice expense6.14
6.14 RVUs× 1.000 GPCI
Malpractice1.05
1.05 RVUs× 1.000 GPCI
Adjusted RVUs
14.3200
Conversion factor
$33.4009
Medicare rate
$478.30
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 42815
42815 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 42815
Neck cyst excision
| 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) | 1 | Bilateral with modifier 50 pays 150% of the fee schedule amount. |
| Assistant at surgery (80/81/82/AS) | 2 | Paid. |
| Co-surgeons (62) | 1 | Permitted with supporting documentation. |
| 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 · 42815
Neck cyst excision
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 50 · payment effect
With and without the modifier
42815 without 50 · national facility
$478.30
Neck cyst excision
42815-50 · Bilateral: 150%
$717.45
Both sides on one line with modifier 50 are paid at 150% of the fee schedule amount (subject to multiple-procedure rules with other procedures).
42815 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 42810Neck cyst excision
- 42810 is the more limited branchial cleft cyst, remnant, or fistula excision. Choose 42815 when the documented lesion extends below the hyoid.
- 60280Duct lesion excision
- 60280 is used for a thyroglossal duct cyst or sinus. A branchial cleft cyst, vestige, or fistula extending below the hyoid is reported with 42815.
- 21555Mass excision
- 21555 describes excision of a subcutaneous neck soft-tissue tumor. It is not the code for removal of a branchial cleft cyst or tract.
- 21556Tumor excision
- 21556 describes excision of a deep neck soft-tissue tumor. Use 42815 when the documented lesion is a branchial cleft cyst, vestige, or fistula extending below the hyoid.
42815 billing questions
How does 42815 differ from 42810?
Use 42815 when the branchial cleft cyst, remnant, or fistula extends below the hyoid. Code 42810 describes the more limited excision.
What operative documentation supports 42815?
Document the lesion or tract, its anatomic extent below the hyoid, and the dissection and removal performed. State whether the procedure was unilateral or bilateral.
Does the 90-day global include postoperative visits?
It includes related postoperative care for 90 days, as well as the day-before preoperative visit.
How is bilateral excision reported?
When the procedure is performed bilaterally, report modifier 50; CMS pays the bilateral procedure at 150%.
Can an assistant or co-surgeon be reported?
Assistant-at-surgery payment may be available. Co-surgeons are paid only with supporting documentation, and team surgery is not permitted.
What happens when another procedure is performed in the same session?
The highest-valued procedure is paid in full, and other procedures are subject to the standard multiple-procedure reduction, with payment at 50%.
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
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