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See a sample rate comparisonCPT 42320 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 | 21 - Inpatient Hospital 11 - Office 22 - On Campus Outpatient Hospital |
| Common Modifiers | RT - Right side of body 78 - Return to OR - related procedure |
| Complexity Level | Moderate |
| Medicare Fee Schedule | $261.53 national non-facility rate (2026) · View Medicare rates for 42320 |
| Medicaid Fee Schedule | $203.83 median of the 8 states in the free preview · View Medicaid rates for 42320 |
National average reimbursement for CPT 42320 by major payers:
$330.52
$331.83
$350.94
$300.16
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CPT 42320
5 of 25 sample ratesHigher to lower in this preview
Peak One Surgery Center, LLC, Peak One Surgery Center
Peak One Surgery Center LLC
$1,727.00Published rateSurgical Specialty Center Of Mid Atlantic, LLC
Surgical Specialty Center Of Mid-Atlantic, LLC
$531.00Published rateDesert Cliffs Surgery Center LLC
$340.00Published rateSidney Asc LLC, Valley Regional Surgery Center
Valley Regional Surgery Center
$129.00Published rateKunesh Eye Surgery Center
$91.00Published rate
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See a sample payer proposalCPT 42320 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 42320 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 42320 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. |
| 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. |
| 42340-CPT | Moderate | Sialolithotomy Parotid Extra, Sialolithotomy Parotid Extraoral Or Complicated Intraoral Sialolithotomy Parotid Extraoral Or Complicated Intraoral |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 42320. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 42320 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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