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See a sample rate comparisonCPT 42500 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.
Plastic Repair Of Salivary Duc, Plastic Repair Of Salivary Duct Sialodochoplastyprimaryor Simple Plastic Repair Of Salivary Duct Sialodochoplasty Primary
| Key Fact | Detail |
|---|---|
| Service Type | Surgery Surgical Procedures on the Digestive System |
| Common Place of Service | 22 - On Campus Outpatient Hospital 11 - Office |
| Common Modifiers | LT - Left side of body RT - Right side of body |
| Complexity Level | Moderate |
| Medicare Fee Schedule | $448.91 national non-facility rate (2026) · View Medicare rates for 42500 |
| Medicaid Fee Schedule | $358.245 median of the 8 states in the free preview · View Medicaid rates for 42500 |
National average reimbursement for CPT 42500 by major payers:
$596.89
$573.90
$626.87
$574.21
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CPT 42500
5 of 25 sample ratesHigher to lower in this preview
Yorkville Endoscopy, LLC
Yorkville Endoscopy LLC
$5,947.54Published rateAz West Endoscopy Center LLC
$2,353.00Published rateGeorgia Interventional Pain
$1,600.00Published rateSouth County Outpatient Surgery Center, LLC
South County Outpatient Surgery Center LLC
$1,025.00Published rateHoliday Surgery Center Limited Partnership L L P
$715.00Published rate
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See a sample payer proposalCPT 42500 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 42500 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 42500 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 |
|---|---|---|
| 42500-CPT | Moderate | Plastic Repair Of Salivary Duc, Plastic Repair Of Salivary Duct Sialodochoplastyprimaryor Simple Plastic Repair Of Salivary Duct Sialodochoplasty Primary |
| 42505-CPT | Moderate | Plastic Repair Of Salivary Duc, Plastic Repair Of Salivary Duct Sialodochoplastysecondaryor Complicated Plastic Repair Of Saliva Ry Duct Sialodochoplasty Secondary |
| 42507-CPT | Moderate | Bypass Blockage In Saliva Duct, Surgery To Reposition The Parotid Gland To Bypass A Blockage And Allow Saliva To Flow Freely Into The Mouth. |
| 42509-CPT | High | Bypass Blockage In Saliva Duct, Surgery To Reposition The Parotid Gland To Bypass A Blockage And Allow Saliva To Flow Freely Into The Mouth. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 42500. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 42500 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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