Rate Benchmarking
Compare your rates with similar providers.
Select a published rate, define comparable providers, and see where that rate falls in your market.
See a sample rate comparisonCPT 42405 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.
Saliva Gland Biopsy, A Procedure To Remove A Sample Of Tissue From A Saliva Gland For Testing (Biopsy). The Sample May Be Taken In A Surgery Or With A Needle.
| Key Fact | Detail |
|---|---|
| Service Type | Surgery Surgical Procedures on the Digestive System |
| Common Place of Service | 11 - Office 22 - On Campus Outpatient Hospital |
| Common Modifiers | RT - Right side of body LT - Left side of body |
| Complexity Level | Moderate |
| Medicare Fee Schedule | $306.95 national non-facility rate (2026) · View Medicare rates for 42405 |
| Medicaid Fee Schedule | $245.67 median of the 8 states in the free preview · View Medicaid rates for 42405 |
National average reimbursement for CPT 42405 by major payers:
$389.67
$397.32
$427.81
$378.25
Compare published rates across providers.
Choose a payer to see a sample of rates for CPT 42405.
CPT 42405
5 of 25 sample ratesHigher to lower in this preview
South Jersey Musculoskeletal Institute, LLC, Advanced Surgical Institute
South Jersey Musculoskeletal Institute, LLC
$2,382.00Published rateSaint Thomas Surgery Center New Salem, LLC
Saint Thomas Surgery Center New Salem LLC
$1,276.00Published rateNorth Scottsdale Ambulatory Surgery Center, LLC
North Scottsdale Ambulatory Surgery Center LLC
$947.00Published rateWarm Springs Surgical Center, LLC, Warm Springs Surgical Center
Warm Springs Surgical Center LLC
$560.00Published rateJennifer Lampert
Deaconess Hospital Inc
$242.16Published rate
Get a free rate benchmark for your specialty.
Choose your state and specialty to build a report from payer-published rates.
Use market rates to prepare your payer proposal.
Payer Contract Negotiation
Draft a fee schedule renegotiation letter.
Use your fee schedule and market benchmarks to set target rates and draft a letter for your payer.
See a sample payer proposalCPT 42405 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 42405 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 42405 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 |
|---|---|---|
| 42400-CPT | Low | Saliva Gland Biopsy, A Procedure To Remove A Sample Of Tissue From A Saliva Gland For Testing (Biopsy). The Sample May Be Taken In A Surgery Or With A Needle. |
| 42405-CPT | Moderate | Saliva Gland Biopsy, A Procedure To Remove A Sample Of Tissue From A Saliva Gland For Testing (Biopsy). The Sample May Be Taken In A Surgery Or With A Needle. |
| 42410-CPT | Moderate | Xcision Of Parotid Tumor/Parotid Gland; Lateral Lobe W/O Nerv, Excision Of Parotid Tumor Or Parotid Gland; Lateral Lobe Without Nerv |
| 42440-CPT | Moderate | Exc Submandibular Gland |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 42405. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 42405 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.
FREE SAMPLE MARKET COMPARISON
Let's review your payer contracts side-by-side with the market.
Bring your top codes (like CPT 42405) and we'll show you how you compare in 15 minutes or less.