No office rate
Both describe lateral-lobe parotid excision, but 42415 includes facial nerve dissection and preservation; 42410 does not.
On this page
CMS RVU26D · Effective 2026-10-01
42415 Parotid excision Medicare reimbursement rates in Wisconsin
Reports removal of a parotid lesion or lateral gland lobe when the surgeon dissects and preserves the facial nerve during surgery. Compare 42415 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 42415 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
No supported rate
Facility setting
$850.52
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.
Head and neck surgery
About 42415: Lateral parotid excision with nerve preservation
Reports removal of a parotid lesion or lateral gland lobe when the surgeon dissects and preserves the facial nerve during surgery.
An otolaryngologist or head and neck surgeon reports this operation when removing a lesion from the lateral lobe of the parotid, or removing that lobe, while dissecting and preserving the facial nerve. It may be performed for a parotid mass, such as a benign salivary tumor, in a hospital or other surgical setting. The nerve dissection and preservation are defining features of this service, not simply incidental details of a lesion excision.
Choose the code based on the operative extent and documented facial nerve management, not pathology results alone. The operative report should identify the parotid tissue removed and describe the nerve dissection and preservation. This major surgery has a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. For multiple procedures in one session, the highest-valued procedure is paid in full and other procedures at 50%. Bilateral reporting with modifier 50 is paid at 150%. An assistant at surgery may be paid; co-surgeons are paid only with supporting documentation, and team surgery is not permitted.
CMS billing rules for 42415
- 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 may be paid.
- Co-surgeons
- Co-surgeons paid only with supporting documentation.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU16.73 · 61%
- Practice expense (office) RVU8.31 · 30%
- Malpractice RVU2.51 · 9%
5.7K
Medicare services in 2024 · #1786 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.
42415 compared with similar codes
Office rates for Wisconsin, from the same CMS release.
No office rate
42420 describes total parotid excision with facial nerve dissection and preservation. Choose 42415 when the operation is limited to the lateral lobe.
$89.88
42400 is for biopsy of a salivary gland to obtain tissue for diagnosis; 42415 is an operation removing parotid tissue or a lesion with facial nerve dissection and preservation.
Compare 42415 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
Unavailable
Facility
$850.52
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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 42415 in Wisconsin.
PPRRVU2026_Oct_nonQPP.csv
5,033
- Code
- 42415
- Physician work
- 16.73
- Practice expense
- 8.31
- Malpractice
- 2.51
GPCI2026.csv
111
- Locality
- Wisconsin
- Physician work
- 1.000
- Practice expense
- 0.958
- Malpractice
- 0.308
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 16.73 | × 1.000 | 16.7300 |
| Practice expense | 8.31 | × 0.958 | 7.9610 |
| Malpractice | 2.51 | × 0.308 | 0.7731 |
| Total RVUs | 25.4641 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Wisconsin$850.52
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 16.73 | 1 |
| Practice expense | 8.31 | 0.958 |
| Malpractice | 2.51 | 0.308 |
(16.73 × 1 + 8.31 × 0.958 + 2.51 × 0.308) × $33.4009 = $850.52
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.
42415 billing questions
How does 42415 differ from 42410?
42415 includes dissection and preservation of the facial nerve during lateral-lobe excision. 42410 is for lateral-lobe excision without that nerve dissection and preservation.
When is 42420 more appropriate?
Use 42420 when the operative service removes the total parotid gland with facial nerve dissection and preservation, rather than excising the lateral lobe.
Is facial nerve dissection separately reported?
The dissection and preservation of the facial nerve are part of the service represented by 42415. The operative report should document that work and the extent of parotid removal.
What postoperative care is included?
The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.
Can an assistant or co-surgeon be reported?
An assistant at surgery may be paid. Co-surgeons are paid only when supporting documentation is provided; team surgery is not permitted.
How is bilateral surgery handled?
For bilateral performance, modifier 50 applies, and CMS pays the procedure at 150%.
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.
5,03042409,,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
5,03342415,,Excise parotid gland/lesion,A,,16.73,8.31,NA,8.31,,2.51,27.55,27.55,0,090,0.09,0.81,0.10,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,03442420,,Excise parotid gland/lesion,A,,19.04,8.84,NA,8.84,,2.83,30.71,30.71,0,090,0.09,0.81,0.10,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,03542425,,Excise parotid gland/lesion,A,,13.08,6.85,NA,6.85,,1.94,21.87,21.87,0,090,0.09,0.81,0.10,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,03642426,,Excise parotid gland/lesion,A,,22.09,9.34,NA,9.34,,3.48,34.91,34.91,0,090,0.09,0.81,0.10,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
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,,,,,,