CPT 42320 External Salivary Drainage Reimbursement | OpenPayer

Summary & Overview

CPT 42320: External Drainage of Submaxillary Salivary Gland Abscess

CPT code 42320 covers the external surgical drainage of pus from a submaxillary (submandibular) salivary gland. This procedure is performed when an abscess requires direct evacuation via an external incision and is an important element of acute head and neck surgical care. Nationally, correct coding for drainage procedures affects clinical documentation, utilization metrics, and facility billing for ambulatory surgery centers and hospital operating rooms.

Key payers addressed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise explanation of the clinical scenario that typically triggers use of this code, common sites of service, and the implications for coding and billing workflows. The publication presents benchmarks where available, summarizes relevant policy and coverage considerations, and situates the procedure within clinical context for surgeons and billing professionals.

The content is designed to help clinicians, coding specialists, and revenue cycle staff understand when to apply CPT code 42320, what documentation supports the code selection, and which settings of care are most common for the service. Data not available in the input that would normally appear in appendices (such as associated taxonomies, specific ICD-10 pairings, or detailed payer-specific fee schedules) is noted as unavailable.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare42320CPTsalivary-glandabscess-drainagehead-and-neck-surgeryambulatory-surgeryoperative-proceduresurgical-drainage

Billing Code Overview

CPT code 42320 describes an external approach to drainage of pus from a submaxillary salivary gland. This procedure involves creating an external incision to access and evacuate purulent material from the submandibular (submaxillary) gland when internal or conservative approaches are not appropriate.

Service type: Surgical drainage of salivary gland abscess
Typical site of service: Ambulatory surgery center or hospital operating room

Clinical & Coding Specifications

Clinical Context

A typical patient is an adult presenting to the emergency department or outpatient surgical clinic with acute submandibular (submaxillary) gland swelling, pain, fever, and fluctuance consistent with suppurative sialadenitis or a localized salivary gland abscess. Common predisposing factors include sialolithiasis obstructing the Wharton duct, dehydration, recent ductal instrumentation, xerostomia, or immunocompromise. Initial evaluation includes history, focused head and neck exam, point-of-care ultrasound or formal neck ultrasound to confirm a fluid collection, and laboratory studies (CBC, inflammatory markers). When imaging and exam indicate an abscess confined to the submandibular space that is not amenable to conservative management (antibiotics, hydration, sialagogues, ductal massage) or when immediate source control is required, the surgeon performs an external incision and drainage of the submaxillary salivary gland under local anesthesia with or without sedation, or under general anesthesia for complex or recurrent disease. The workflow includes informed consent, preoperative antibiotics as indicated, aseptic preparation, incision and drainage via an external approach to the submandibular gland, possible placement of a drain, hemostasis, wound dressing, and postoperative instructions with follow-up for drain removal and wound care. Documentation should note the indication, procedure performed as an external approach to drain pus from the submaxillary salivary gland, anesthesia type, estimated blood loss, specimen handling if cultures obtained, drains placed, and postoperative condition.

Coding Specifications

Modifier	Description	When to Use
`22`

CPT 42330: Sialolithotomy, Removal of Salivary Gland Stone

CPT-42335-SIALOLITHOTOMY-SALIVARY-GLAND-STONE-REMOVAL

CPT 42335: Sialolithotomy, Removal of Salivary Gland Stone

CPT-42340-SIALOLITHOTOMY-PAROTID-GLAND-REMOVAL

CPT 42340: Sialolithotomy, Removal of Parotid Gland Stone

CPT-42305-PAROTID-ABSCESS-DRAINAGE-COMPLEX

CPT 42305: Complex Drainage of Parotid Gland Abscess

CPT-42310-INCISION-DRAINAGE-SUBMANDIBULAR-SUBLINGUAL-ABSCESS

CPT 42310: Incision and Drainage of Submaxillary/Sublingual Salivary Gland Abscess

CPT-42300-PAROTID-ABSCESS-DRAINAGE

CPT 42300: Drainage of Parotid Gland Abscess

Taxonomy Code	Specialty	Notes
207R00000X	Otolaryngology (ENT)	Most common specialty performing external salivary gland drainage.
208800000X	Oral and Maxillofacial Surgery	Performs gland excision or complex drainage when intraoral or external approaches are needed.
2080P0200X	General Surgery	May perform drainage in emergent settings or when head and neck surgeon is unavailable.
363L00000X	Emergency Medicine	May perform bedside incision and drainage in ED under local anesthesia prior to definitive surgical management.
367500000X	Plastic and Reconstructive Surgery	Involved when complex soft tissue reconstruction or scar-minimizing approaches are planned.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`K11.2`	Sialadenitis	Acute or chronic inflammation of salivary gland commonly leading to abscess requiring drainage.
`K11.3`	Abscess of salivary gland	Direct indication for incision and drainage of the submaxillary gland.
`K11.5`	Sialolithiasis	Salivary duct stones predispose to obstruction and secondary infection/abscess formation.
`K12.2`	Cellulitis and abscess of mouth	Surrounding soft tissue infection that can extend to submandibular space necessitating drainage.
`L03.224`	Cellulitis of neck	Deep neck infections involving submandibular region that may require external drainage.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`40430`	Excision of submandibular gland (partial or total)	Definitive gland excision performed when recurrent infection, chronic sialadenitis, or neoplasm is present; may follow or replace `42320` if drainage is insufficient.
`41800`	Incision and drainage of abscess, intraoral, soft tissue of floor of mouth	Alternative intraoral drainage approach for accessible ductal or floor-of-mouth collections instead of external `42320`.
`20526`	Injection, therapeutic, botulinum toxin, salivary gland (parotid or submandibular), per gland	Adjunctive treatment for chronic sialorrhea or refractory sialadenitis in select cases; not for acute abscess but relevant in salivary disorders.
`76942`	Ultrasonic guidance for needle placement (e.g., aspiration, biopsy, injection), imaging supervision and interpretation	Used when ultrasound guidance is employed for aspiration or localization prior to or during drainage.
`10160`	Puncture aspiration of abscess, simple or single	May be used for percutaneous aspiration of a salivary gland abscess when less invasive drainage is performed instead of open external drainage.

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