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See a sample rate comparisonCPT 42335 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.
Sialolithotomy Submandibular, Sialolithotomy Submandibular (Submaxillary) Complicatedintraoral Sialolithotomy Submandibular (Submaxillary) Complicated
| Key Fact | Detail |
|---|---|
| Service Type | Surgery Surgical Procedures on the Digestive System |
| Common Place of Service | 22 - On Campus Outpatient Hospital 11 - Office |
| Common Modifiers | RT - Right side of body LT - Left side of body |
| Complexity Level | Moderate |
| Medicare Fee Schedule | $428.53 national non-facility rate (2026) · View Medicare rates for 42335 |
| Medicaid Fee Schedule | $335.08 median of the 8 states in the free preview · View Medicaid rates for 42335 |
National average reimbursement for CPT 42335 by major payers:
$482.61
$509.69
$585.96
$443.03
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CPT 42335
5 of 25 sample ratesHigher to lower in this preview
Johnson County Surgery Center, L.P.
Johnson County Surgery Center Lp
$3,273.00Published rateAndrews Institute Asc LLC
Andrews Institute Asc, LLC
$2,056.00Published rateBaptist And Physicians Outpatient Surgery Center Of North Ms, Lp, Oxford Surgery Center
Baptist And Physicians Outpatient Surgery Center Of North Ms Lp
$1,148.00Published rateAmbulatory Surgery Center At Indiana Eye Clinic LLC
$974.00Published rateFour Corners Ambulatory Surgical Center LLC
$475.00Published rate
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Payer Contract Negotiation
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See a sample payer proposalCPT 42335 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 42335 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 42335 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 |
|---|---|---|
| 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. |
| 42330-CPT | Moderate | Sialolithotomy Submandibular, Sialolithotomy Submandibular (Submaxillary) Sublingual Or Parotid Uncomplicated Intraoral Sialolithotomy Submandibular (Submaxillary) Sublingual Or |
| 42335-CPT | Moderate | Sialolithotomy Submandibular, Sialolithotomy Submandibular (Submaxillary) Complicatedintraoral Sialolithotomy Submandibular (Submaxillary) Complicated |
| 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 42335. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 42335 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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