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See a sample rate comparisonCPT 42409 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.
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.
| 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 | LT - Left side of body RT - Right side of body |
| Complexity Level | Moderate |
| Medicare Fee Schedule | $387.12 national non-facility rate (2026) · View Medicare rates for 42409 |
| Medicaid Fee Schedule | $302.755 median of the 8 states in the free preview · View Medicaid rates for 42409 |
National average reimbursement for CPT 42409 by major payers:
$474.90
$457.65
$515.87
$394.27
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CPT 42409
5 of 25 sample ratesHigher to lower in this preview
Florida Springs Surgery Center LLC
Florida Springs Surgery Center L
$2,859.00Published ratePhysicians Pavilion Lp, Physicians Pavilion Surgery Center
$1,762.00Published rateFresno Ca Multi Asc Lp, Herndon Surgery Center
Fresno Ca Multi Asc
$1,200.00Published rateValley Digestive Center Inc, Valley Digestive Health Center
$927.00Published rateDigestive Health Complex
$530.00Published rate
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See a sample payer proposalCPT 42409 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 42409 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 42409 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. |
| 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 |
| 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 42409. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 42409 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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