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See a sample rate comparisonCPT 42415 Fee Schedule
Last Verified: October 2026
Healthcare providers use this code to document and receive reimbursement for visits that address high-level medical decision-making, often including multiple diagnoses or prescription management.
Excision Of Parotid Tumor Or P, Excision Of Parotid Tumor Or Parotid Gland Lateral Lobewith Dissection And Preservation Of Facial Nerve
| Key Fact | Detail |
|---|---|
| Service Type | Surgery Surgical Procedures on the Digestive System |
| Common Place of Service | 22 - On Campus Outpatient Hospital 24 - Ambulatory Surgical Center |
| Common Modifiers | LT - Left side of body RT - Right side of body |
| Complexity Level | High |
| Medicare Fee Schedule | $920.20 national non-facility rate (2026) · View Medicare rates for 42415 |
| Medicaid Fee Schedule | $782.745 median of the 8 states in the free preview · View Medicaid rates for 42415 |
National average reimbursement for CPT 42415 by major payers:
$1,508.01
$1,442.34
$1,555.58
$1,739.33
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CPT 42415
5 of 25 sample ratesHigher to lower in this preview
Medical City Surgery Center Of Alliance, LLC
Medical City Surgery Center Of Alliance LLC
$7,124.00Published rateE Street Endoscopy LLC, West Coast Endoscopy
E Street Endoscopy
$3,275.00Published rateFasa Family Wellness, PLLC
Fasa Family Wellness PLLC
$2,225.00Published rateWake Endoscopy Center, LLC
$1,488.00Published rateWanda Murray
Deaconess Hospital Inc
$854.17Published rate
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Payer Contract Negotiation
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See a sample payer proposalCPT 42415 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 42415 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 42415 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 |
|---|---|---|
| 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 |
| 42415-CPT | High | Excision Of Parotid Tumor Or P, Excision Of Parotid Tumor Or Parotid Gland Lateral Lobewith Dissection And Preservation Of Facial Nerve |
| 42420-CPT | High | Xcision Of Parotid Tumor/Parotid Gland; Total W/ Dissect &, Excision Of Parotid Tumor Or Parotid Gland; Total With Dissection And |
| 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 42415. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 42415 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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