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See a sample rate comparisonCPT 42340 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 Parotid Extra, Sialolithotomy Parotid Extraoral Or Complicated Intraoral Sialolithotomy Parotid Extraoral Or Complicated Intraoral
| 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 | LT - Left side of body RT - Right side of body |
| Complexity Level | Moderate |
| Medicare Fee Schedule | $525.73 national non-facility rate (2026) · View Medicare rates for 42340 |
| Medicaid Fee Schedule | $410.305 median of the 8 states in the free preview · View Medicaid rates for 42340 |
National average reimbursement for CPT 42340 by major payers:
$642.37
$634.77
$701.48
$576.83
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CPT 42340
5 of 25 sample ratesHigher to lower in this preview
Memorial Hermann Surgery Center Memorial City LLC, Memorial Hermann Memorial Village Surgery Center
$2,480.00Published rateNorthwest Ambulatory Surgery Center LLC, Northwest Ambulatory Surgery Center
Northwest Ambulatory Surgery Center LLC
$1,311.00Published rateJamie Davison
Deaconess Hospital Inc
$847.42Published rateCenter Of Morehead City, LLC, The Surgical Center Of Morehead City
Surgical Center Of Morehead
$580.00Published rateMark Janorschke
Deaconess Hospital Inc
$389.35Published rate
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See a sample payer proposalCPT 42340 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 42340 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 42340 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. |
| 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 |
| 42415-CPT | High | Excision Of Parotid Tumor Or P, Excision Of Parotid Tumor Or Parotid Gland Lateral Lobewith Dissection And Preservation Of Facial Nerve |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 42340. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 42340 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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