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See a sample rate comparisonCPT 42600 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.
Close Salivary Fistula
| 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 | 78 - Return to OR - related procedure 51 - Multiple procedures |
| Complexity Level | Moderate |
| Medicare Fee Schedule | $539.43 national non-facility rate (2026) · View Medicare rates for 42600 |
| Medicaid Fee Schedule | $420.765 median of the 8 states in the free preview · View Medicaid rates for 42600 |
National average reimbursement for CPT 42600 by major payers:
$636.48
$656.58
$715.90
$591.72
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CPT 42600
5 of 25 sample ratesHigher to lower in this preview
Mercy Catholic Medical Center Of Southeastern PA, Mercy Philadelphia Hospital Short Procedure Unit
Mercy Catholic Medical Center Of Southeastern PA
$3,598.00Published rateBethesda Chevy Chase Surgery Center, LLC
Bethesda Chevy Chase Surgery Cen
$1,258.00Published rateSkin Surgery Center Ps, Skin Surgery Center
Skin Surgery Center P. S.
$916.00Published rateModesto Specialty Surgery Center, PC
Modesto Specialty Surgery Center PC
$557.00Published rateFour Corners Ambulatory Surgical Center LLC
$197.00Published rate
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See a sample payer proposalCPT 42600 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 42600 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 42600 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 |
|---|---|---|
| 42600-CPT | Moderate | Close Salivary Fistula |
| 42650-CPT | Low | Dilate Salivary Duct |
| 42660-CPT | Low | Dilation And Catheterization, Dilation And Catheterization Of Salivary Duct With Orwithout Injection Dilation And Catheterization Of Salivary Duct With Or |
| 42665-CPT | Moderate | Ligate Salivary Duct Intraoral |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 42600. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 42600 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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