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See a sample rate comparisonCPT 42408 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.
Exc Sublingual Salivary Cyst
| 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 | $570.15 national non-facility rate (2026) · View Medicare rates for 42408 |
| Medicaid Fee Schedule | $445.71 median of the 8 states in the free preview · View Medicaid rates for 42408 |
National average reimbursement for CPT 42408 by major payers:
$644.85
$648.80
$714.86
$573.10
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CPT 42408
5 of 25 sample ratesHigher to lower in this preview
Greater Dayton Surgery Center LLC
Greater Dayton Surgery Center
$7,441.00Published rateAlabama Digestive Health Endoscopy Center, LLC
Alabama Digestive Health
$2,307.00Published ratePalm Beach Regional Opco LLC
$1,611.00Published rateJohn Kenyon American Eye Institute LLC, Eye Surgery Center Of Elizabethtown
John-Kenyon American Eye Institute
$1,185.00Published ratePublic Hospital Dist No 1 Skagit
$743.00Published rate
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See a sample payer proposalCPT 42408 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 42408 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 42408 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 |
|---|---|---|
| 42408-CPT | Moderate | Exc Sublingual Salivary Cyst |
| 42409-CPT | Moderate | Treat Cyst Of Saliva Gland, Surgery To Treat A Pocket Of Fluid (Cyst) Located On The Floor Of The Mouth To Allow For Drainage From A Gland Under The Tongue. |
| 42450-CPT | Moderate | Excision Sublingual Gland |
| 42500-CPT | Moderate | Plastic Repair Of Salivary Duc, Plastic Repair Of Salivary Duct Sialodochoplastyprimaryor Simple Plastic Repair Of Salivary Duct Sialodochoplasty Primary |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 42408. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 42408 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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