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See a sample rate comparisonCPT 42650 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.
Dilate Salivary Duct
| Key Fact | Detail |
|---|---|
| Service Type | Surgery Surgical Procedures on the Digestive System |
| Common Place of Service | 11 - Office 22 - On Campus Outpatient Hospital |
| Common Modifiers | LT - Left side of body RT - Right side of body |
| Complexity Level | Low |
| Medicare Fee Schedule | $76.82 national non-facility rate (2026) · View Medicare rates for 42650 |
| Medicaid Fee Schedule | $61.475 median of the 8 states in the free preview · View Medicaid rates for 42650 |
National average reimbursement for CPT 42650 by major payers:
$105.99
$105.97
$108.97
$100.20
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CPT 42650
5 of 25 sample ratesHigher to lower in this preview
Walnut Creek Surgical Suites, LLC
Walnut Creek Surgical Suites LLC
$2,134.00Published rateColorado Urologic Surgery Center LLC
$1,276.00Published rateOlol Pontchartrain Surgery Center, LLC, Our Lady Of The Lake Pontchartrain Surgery Center
Olol Pontchartrain Surgery Cente
$774.00Published rateBellevue Plastic Surgery Center, Newvue Plastic Surgery PC
Newvue Plastic Surgery, PC
$585.00Published rateDavid Sandage
Deaconess Hospital Inc
$65.12Published rate
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See a sample payer proposalCPT 42650 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 42650 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 42650 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 42650. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 42650 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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