$223.75
Use 42330 for uncomplicated salivary-stone removal. Choose 42340 when the documented procedure is complicated.
On this page
CMS RVU26D · Effective 2026-10-01
42340 Stone removal Medicare reimbursement rates in Wisconsin
Reports operative removal of a salivary stone when the procedure is complicated, with the gland, approach, and operative complexity documented. Compare 42340 office and facility rates across CMS payment localities in Wisconsin.
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 42340 in Wisconsin?
Wisconsin 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
$495.77
1 of 1 localities have a supported rate.
Payment area: Wisconsin
One mapped payment locality.
Facility setting
$288.11
1 of 1 localities have a supported rate.
Payment area: Wisconsin
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 42340: Complicated salivary stone removal
Reports operative removal of a salivary stone when the procedure is complicated, with the gland, approach, and operative complexity documented.
An otolaryngologist or oral and maxillofacial surgeon may remove a salivary calculus that obstructs a duct or gland and causes symptoms such as painful swelling, often around meals. The stone may involve a submandibular, sublingual, or parotid gland. This code represents the complicated procedure in the salivary-stone removal family; the operative report should identify the stone location, surgical approach, and features supporting the documented complexity.
Select this code when the performed stone-removal procedure meets the complicated level, rather than the uncomplicated service represented by 42330. The code has a 90-day global period: the day-before preoperative visit and related postoperative care during that period are included. For multiple procedures in one session, Medicare pays the highest-valued procedure in full and applies the standard reduction to the others. When performed bilaterally with modifier 50, payment is at 150%. Assistant-at-surgery payment requires documented medical necessity; co-surgeons and team surgery are not permitted.
CMS billing rules for 42340
- 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 procedure with modifier 50 is paid at 150%.
- 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 RVU4.60 · 29%
- Practice expense (office) RVU10.48 · 67%
- Malpractice RVU0.66 · 4%
93
Medicare services in 2024 · #4934 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.
42340 compared with similar codes
Office rates for Wisconsin, from the same CMS release.
$172.78
42310 describes salivary-gland drainage. 42340 is for operative removal of a salivary calculus.
$404.77
Both codes concern salivary-stone removal, but they represent distinct code-family services. Compare the full descriptor with the documented gland and procedure.
Compare 42340 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
Wisconsin →
Office / nonfacility
$495.77
Facility
$288.11
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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 42340 in Wisconsin.
PPRRVU2026_Oct_nonQPP.csv
5,026
- Code
- 42340
- Physician work
- 4.60
- Practice expense
- 10.48
- Malpractice
- 0.66
GPCI2026.csv
111
- Locality
- Wisconsin
- Physician work
- 1.000
- Practice expense
- 0.958
- Malpractice
- 0.308
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 4.60 | × 1.000 | 4.6000 |
| Practice expense | 10.48 | × 0.958 | 10.0398 |
| Malpractice | 0.66 | × 0.308 | 0.2033 |
| Total RVUs | 14.8431 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Wisconsin$495.77
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 4.6 | 1 |
| Practice expense | 10.48 | 0.958 |
| Malpractice | 0.66 | 0.308 |
(4.6 × 1 + 10.48 × 0.958 + 0.66 × 0.308) × $33.4009 = $495.77
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 4.6 | 1 |
| Practice expense | 3.99 | 0.958 |
| Malpractice | 0.66 | 0.308 |
(4.6 × 1 + 3.99 × 0.958 + 0.66 × 0.308) × $33.4009 = $288.11
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.
42340 billing questions
How is 42340 distinguished from 42330?
42340 is the complicated salivary-stone removal service; 42330 represents the uncomplicated service. The operative report should support the level selected.
What documentation supports the complicated level?
Document the affected gland or duct, the approach, the stone removal performed, and the operative circumstances that support classifying the procedure as complicated.
Can modifier 50 be used for bilateral stone removal?
CMS identifies this as a bilateral procedure. When reporting bilateral performance with modifier 50, payment is at 150%.
What postoperative care is included?
The 90-day global period includes the day-before preoperative visit and related postoperative care during the 90 days after surgery.
When is an assistant at surgery payable?
Assistant-at-surgery payment is allowed only when medical necessity is documented. Co-surgeons and team surgery are not permitted for this code.
How are multiple procedures in the same session paid?
The highest-valued procedure is paid in full, and the other procedures are subject to the standard multiple-procedure reduction.
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.
5,02342320,,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
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
10802402,WA,02,SEATTLE (KING CNTY),1.050,1.227,0.817
10902402,WA,99,REST OF WASHINGTON,1.013,1.053,0.761
11011402,WV,16,WEST VIRGINIA,1.000,0.869,1.431
11106302,WI,00,WISCONSIN,1.000,0.958,0.308
11203602,WY,21,WYOMING**,1.000,1.000,0.740
113"MAC Assignments as of November 22, 2023",,,,,,
114,,,,,,