$566.35
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.
On this page
CMS RVU26D · Effective 2026-10-01
42500 Duct repair Medicare reimbursement rates in Wyoming
Repair of an injured or disrupted salivary duct, reported when the surgeon restores duct continuity rather than creating a diversion. Compare 42500 office and facility rates across CMS payment localities in Wyoming.
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 42500 in Wyoming?
Wyoming 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
$443.52
1 of 1 localities have a supported rate.
Payment area: Wyoming**
One mapped payment locality.
Facility setting
$307.92
1 of 1 localities have a supported rate.
Payment area: Wyoming**
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 42500: Salivary duct repair
Repair of an injured or disrupted salivary duct, reported when the surgeon restores duct continuity rather than creating a diversion.
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.
CMS billing rules for 42500
- 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 RVU4.31 · 32%
- Practice expense (office) RVU8.51 · 63%
- Malpractice RVU0.62 · 5%
258
Medicare services in 2024 · #4112 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.
42500 compared with similar codes
Office rates for Wyoming, from the same CMS release.
No office rate
This code is for duct diversion, which redirects salivary flow. Use 42500 when the surgeon repairs the duct itself.
No office rate
This is a diversion procedure, not a repair. The operative report should show whether the duct was redirected or restored.
Compare 42500 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
Wyoming** →
Office / nonfacility
$443.52
Facility
$307.92
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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 42500 in Wyoming**.
PPRRVU2026_Oct_nonQPP.csv
5,042
- Code
- 42500
- Physician work
- 4.31
- Practice expense
- 8.51
- Malpractice
- 0.62
GPCI2026.csv
112
- Locality
- Wyoming**
- Physician work
- 1.000
- Practice expense
- 1.000
- Malpractice
- 0.740
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 4.31 | × 1.000 | 4.3100 |
| Practice expense | 8.51 | × 1.000 | 8.5100 |
| Malpractice | 0.62 | × 0.740 | 0.4588 |
| Total RVUs | 13.2788 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Wyoming**$443.52
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 4.31 | 1 |
| Practice expense | 8.51 | 1 |
| Malpractice | 0.62 | 0.74 |
(4.31 × 1 + 8.51 × 1 + 0.62 × 0.74) × $33.4009 = $443.52
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 4.31 | 1 |
| Practice expense | 4.45 | 1 |
| Malpractice | 0.62 | 0.74 |
(4.31 × 1 + 4.45 × 1 + 0.62 × 0.74) × $33.4009 = $307.92
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.
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 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.
5,03942450,,Excise sublingual gland,A,,4.62,8.85,,4.58,,0.66,14.13,9.86,0,090,0.09,0.81,0.10,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,0404245F,,Pt instr nrml activities,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
5,0414248F,,Pt instr no bd rest 4 days/>,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
5,04242500,,Repair salivary duct,A,,4.31,8.51,,4.45,,0.62,13.44,9.38,0,090,0.09,0.81,0.10,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,04342505,,Repair salivary duct,A,,6.16,10.13,,5.22,,0.90,17.19,12.28,0,090,0.09,0.81,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,04442507,,Parotid duct diversion,A,,6.09,6.24,NA,6.24,,0.89,13.22,13.22,0,090,0.09,0.81,0.10,2,2,2,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,04542509,,Parotid duct diversion,A,,11.47,8.38,NA,8.38,,1.67,21.52,21.52,0,090,0.09,0.81,0.10,2,2,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
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,,,,,,
115*Work GPCI reflects a 1.5 floor in Alaska established by the MIPPA.,,,,,,