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See a sample rate comparisonCPT 42509 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.
Bypass Blockage In Saliva Duct, Surgery To Reposition The Parotid Gland To Bypass A Blockage And Allow Saliva To Flow Freely Into The Mouth.
| Key Fact | Detail |
|---|---|
| Service Type | Surgery Surgical Procedures on the Digestive System |
| Common Place of Service | 22 - On Campus Outpatient Hospital 21 - Inpatient Hospital |
| Complexity Level | High |
| Medicare Fee Schedule | $718.79 national non-facility rate (2026) · View Medicare rates for 42509 |
| Medicaid Fee Schedule | $580.915 median of the 8 states in the free preview · View Medicaid rates for 42509 |
National average reimbursement for CPT 42509 by major payers:
$1,077.12
$1,123.05
$1,147.48
$1,353.96
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CPT 42509
5 of 25 sample ratesHigher to lower in this preview
New Gulf Coast Surgery Center, LLC
Gulfport Surgery Clinic, LLC
$11,260.00Published rateSouth Portland Surgical Center LLC, South Portland Surgical Center
South Portland Surgical Center, LLC
$3,235.00Published rateNorthfield Surgical Center LLC, Northfield Surgical Center
Northfield Surgical Center LLC
$2,622.00Published rateDelmar Surgical Center LLC
$1,667.00Published rateGraystone Eye Surgery Center Of Hickory, Lp, Graystone Eye Surgery Center
$1,230.00Published rate
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See a sample payer proposalCPT 42509 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 42509 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 42509 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 42509. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 42509 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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