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See a sample rate comparisonCPT 42310 Fee Schedule
Last Verified: October 2026
Healthcare providers use this code to document and receive reimbursement for visits that address moderate-level medical decision-making, often including multiple diagnoses or prescription management.
Drain Saliva Gland Abscess, Surgery To Drain Blood Pus Or Infected Fluid From An Abscess (Pocket Of Infection) Of The Saliva Gland.
| Key Fact | Detail |
|---|---|
| Service Type | Surgery Surgical Procedures on the Digestive System |
| Common Place of Service | 11 - Office 21 - Inpatient Hospital |
| Common Modifiers | RT - Right side of body 51 - Multiple procedures |
| Complexity Level | Moderate |
| Medicare Fee Schedule | $183.04 national non-facility rate (2026) · View Medicare rates for 42310 |
| Medicaid Fee Schedule | $144.115 median of the 8 states in the free preview · View Medicaid rates for 42310 |
National average reimbursement for CPT 42310 by major payers:
$224.35
$222.92
$232.55
$273.76
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CPT 42310
5 of 25 sample ratesHigher to lower in this preview
St. Francis Mooresville Surgery Center, LLC
$3,146.00Published rateGranger Surgery Center LLC, Northern Indiana Surgery Center LLC
Granger Surgery Center LLC
$603.00Published rateScottsdale Surgical Partners LLC, North Valley Surgery Center
$477.00Published rateDigestive Disease Center, Lp, Memorial Care Digestive Care Center Saddleback Memorial, An Affiliate
Digestive Disease Center Lp
$147.00Published rateSame Day Surgery Centers Of Florida LLC, Same Day Surgery Center
Same Day Surgery Centers Of Florida LLC
$75.00Published rate
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Payer Contract Negotiation
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See a sample payer proposalCPT 42310 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 42310 code is part of the Surgery services used for Surgical Procedures on the Digestive System. It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.
The CPT 42310 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.
| Code | Complexity | Description |
|---|---|---|
| 42300-CPT | Moderate | Drain Saliva Gland Abscess, Surgery To Drain Blood Pus Or Infected Fluid From An Abscess (Pocket Of Infection) Of The Saliva Gland. |
| 42305-CPT | Moderate | Drain Saliva Gland Abscess, Surgery To Drain Blood Pus Or Infected Fluid From An Abscess (Pocket Of Infection) Of The Saliva Gland. |
| 42310-CPT | Moderate | Drain Saliva Gland Abscess, Surgery To Drain Blood Pus Or Infected Fluid From An Abscess (Pocket Of Infection) Of The Saliva Gland. |
| 42320-CPT | Moderate | Drain Saliva Gland Abscess, Surgery To Drain Blood Pus Or Infected Fluid From An Abscess (Pocket Of Infection) Of The Saliva Gland. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 42310. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 42310 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.
Factors that affect fee schedules
Medicare & Medicaid Rates
Government-set reimbursement amounts
Private Insurance Rates
Negotiated rates between providers and insurance companies
Geographic Location
Costs may be higher in urban areas.
Provider Type
Hospital providers may have different rates than private practice.
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