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See a sample rate comparisonCPT 42425 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 En Bloc Remval, Excision Of Parotid Tumor Or Parotid Gland; Total En Bloc Removal Wit
| Key Fact | Detail |
|---|---|
| Service Type | Surgery Surgical Procedures on the Digestive System |
| Common Place of Service | 21 - Inpatient Hospital 22 - On Campus Outpatient Hospital |
| Common Modifiers | LT - Left side of body RT - Right side of body |
| Complexity Level | High |
| Medicare Fee Schedule | $730.48 national non-facility rate (2026) · View Medicare rates for 42425 |
| Medicaid Fee Schedule | $588.72 median of the 8 states in the free preview · View Medicaid rates for 42425 |
National average reimbursement for CPT 42425 by major payers:
$1,125.95
$1,132.16
$1,201.30
$1,373.06
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CPT 42425
5 of 25 sample ratesHigher to lower in this preview
Surgery Center Of Southwest Ohio, LLC, The Surgery Center Of Southwest Ohio
The Surgery Center Of Southwest
$11,491.00Published ratePrescott Outpatient Surgical Center LLC
Prescott Outpatient Surgical Center, Lp
$5,354.00Published rateBaptist Surgery And Endoscopy Centers, LLC
$3,320.00Published rateBay Surgery Centers, Clearway Surgery Center Of Kent Island
Bay Surgery Centers
$1,919.00Published rateMidwest Eye Surgery Center, LLC
Midwest Eye Surgery Center LLC
$1,326.00Published rate
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Payer Contract Negotiation
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See a sample payer proposalCPT 42425 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 42425 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 42425 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 |
| 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 |
| 42450-CPT | Moderate | Excision Sublingual Gland |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 42425. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 42425 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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