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See a sample rate comparisonCPT 42420 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.
Xcision Of Parotid Tumor/Parotid Gland; Total W/ Dissect &, Excision Of Parotid Tumor Or Parotid Gland; Total With Dissection And
| Key Fact | Detail |
|---|---|
| Service Type | Surgery Surgical Procedures on the Digestive System |
| Common Place of Service | 22 - On Campus Outpatient Hospital 21 - Inpatient Hospital |
| Common Modifiers | RT - Right side of body LT - Left side of body |
| Complexity Level | High |
| Medicare Fee Schedule | $1,025.74 national non-facility rate (2026) · View Medicare rates for 42420 |
| Medicaid Fee Schedule | $825.96 median of the 8 states in the free preview · View Medicaid rates for 42420 |
National average reimbursement for CPT 42420 by major payers:
$1,626.58
$1,629.85
$1,757.04
$1,956.43
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CPT 42420
5 of 25 sample ratesHigher to lower in this preview
Surgery Center Of Wasilla, LLC
Surgery Center Of Wasilla LLC
$19,404.00Published rateEl Paso Day Surgery LLC, El Paso Day Surgery, L.P.
El Paso Day Surgery LLC
$5,346.00Published rateAnnapolis Endoscopy Center LLC
$2,965.00Published rateAssociates Surgery Centers, LLC
Associates Surgery Centers LLC
$1,600.00Published rateGastro Care, LLC
Gastro Care LLC
$819.00Published rate
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Payer Contract Negotiation
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See a sample payer proposalCPT 42420 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 42420 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 42420 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 |
|---|---|---|
| 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 |
| 42420-CPT | High | Xcision Of Parotid Tumor/Parotid Gland; Total W/ Dissect &, Excision Of Parotid Tumor Or Parotid Gland; Total With Dissection And |
| 42425-CPT | High | Xcision Of Parotid Tumor/Parotid Gland; Total En Bloc Remval, Excision Of Parotid Tumor Or Parotid Gland; Total En Bloc Removal Wit |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 42420. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 42420 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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