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See a sample rate comparisonCPT 42426 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/ Unilat Rad, Excision Of Parotid Tumor Or Parotid Gland; Total With Unilateral Rad
| 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 | $1,166.03 national non-facility rate (2026) · View Medicare rates for 42426 |
| Medicaid Fee Schedule | $935.985 median of the 8 states in the free preview · View Medicaid rates for 42426 |
National average reimbursement for CPT 42426 by major payers:
$1,831.62
$1,830.22
$1,908.32
$2,207.04
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CPT 42426
5 of 25 sample ratesHigher to lower in this preview
Stonesprings Surgicenter, LLC
Stonesprings Surgicenter LLC
$5,379.00Published rateProliance Surgeons Inc Ps, Proliance Center For Specialty Surgery
Proliance Surgeons, Inc., P.S.
$2,408.00Published rateGenesee Care L.L.C., The Surgery Center Of Genesee County
Genesee Care LLC
$2,000.00Published rateRhonda Eubanks
Deaconess Hospital Inc
$1,092.89Published rateDoctors Gi Partnership Ltd, Hf Surgery Center At Babcock
Doctors Gi Partnership Ltd
$525.00Published rate
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See a sample payer proposalCPT 42426 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 42426 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 42426 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 |
|---|---|---|
| 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 |
| 42426-CPT | High | Xcision Of Parotid Tumor/Parotid Gland; Total W/ Unilat Rad, Excision Of Parotid Tumor Or Parotid Gland; Total With Unilateral Rad |
| 42510-CPT | Moderate | Parotid Duct Diversion, Creation Of New Drainage Tracts Of Major Salivary Gland Ducts On Both Sides Of Mouth With Tying Of Salivary Gland Ducts |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 42426. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 42426 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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