CPT 42400 Percutaneous Salivary Biopsy Reimbursement | OpenPayer

Summary & Overview

CPT 42400: Percutaneous Salivary Gland Biopsy

Headline: CPT code 42400: Percutaneous Salivary Gland Biopsy Gains Attention for Diagnostic Role

Lead: CPT code 42400 identifies a percutaneous needle biopsy of a salivary gland — a targeted diagnostic procedure to obtain tissue for pathological analysis. Nationally, this service matters for timely diagnosis of salivary gland masses and can guide surgical and oncologic care.

CPT code 42400 represents a minimally invasive, image-assisted or palpation-guided biopsy procedure performed in outpatient settings to characterize salivary gland lesions. The code is relevant to surgeons, interventional radiologists, otolaryngologists, and pathology services because biopsy results affect treatment planning, surveillance, and potential referrals.

Key payers covered in the analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find benchmarking context for clinical utilization, payer coverage scope, and common billing considerations tied to outpatient procedure coding. The publication outlines typical service settings, clinical indications that prompt use of the code, and how the procedure integrates with pathological evaluation workflows.

What readers will learn: concise benchmarks for national utilization and payment patterns, the clinical context for ordering a percutaneous salivary gland biopsy, and policy or coverage themes that influence billing and claims processing. Data not available in the input is noted where relevant.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareCPT 42400salivary gland biopsypercutaneous biopsydiagnostic pathologyoutpatient proceduresotolaryngologyinterventional radiologyprocedure codingambulatory surgical center

Billing Code Overview

CPT code 42400 describes a percutaneous needle biopsy of a salivary gland, in which a provider obtains tissue samples via a needle approach and sends those specimens for pathological analysis. This procedure is a diagnostic biopsy used to evaluate masses, lesions, or other abnormalities of the salivary glands.

Service type: Percutaneous salivary gland biopsy (diagnostic tissue sampling)
Typical site of service: Outpatient clinic, ambulatory surgical center, or hospital outpatient department where percutaneous image-guided needle procedures are performed.

Clinical & Coding Specifications

Clinical Context

A 54-year-old patient presents to the outpatient otolaryngology clinic with a 2.5 cm, firm, nonmobile swelling in the region of the parotid gland noted over several weeks. The clinician performs a focused history and physical exam, reviews prior imaging (ultrasound or CT), and obtains informed consent for a percutaneous salivary gland needle biopsy. The procedure is performed under ultrasound guidance in an ambulatory procedure room or short-stay unit. Local anesthesia is administered, and the provider advances a percutaneous needle into the gland to obtain core or fine-needle aspiration tissue samples which are placed in appropriate media and sent to pathology for cytologic and/or histologic analysis. Post-procedure vital signs and observation are documented, and patient discharge instructions are provided.

Coding Specifications

Modifier	Description	When to Use
`26`	Professional component	Use when reporting only the physician’s interpretation component when technical component billed separately by another entity.
`50`	Bilateral procedure	Use when biopsy of paired salivary glands (both sides) is performed and payer requires bilateral modifier.

CPT 42410: Excision of Tumor, Lateral Parotid Lobe, No Nerve Dissection

CPT-42409-MARSUPIALIZATION-SUBLINGUAL-SALIVARY-CYST

CPT 42409: Marsupialization of Sublingual Salivary Cyst

CPT-42420-PAROTIDECTOMY-FACIAL-NERVE-PRESERVATION

CPT 42420: Parotidectomy with Facial Nerve Dissection and Preservation

CPT-42426-PAROTIDECTOMY-TOTAL-WITH-RADICAL-NECK-DISSECTION-UNILATERAL

CPT 42426: Total Parotidectomy with Unilateral Radical Neck Dissection

CPT-42405-SALIVARY-GLAND-BIOPSY-EXTERNAL-INCISION

CPT 42405: Open Salivary Gland Biopsy with Pathology

CPT-42450-SUBLINGUAL-GLAND-EXCISION

CPT 42450: Sublingual Gland Excision

CPT-42415-PAROTID-LATERAL-LOBE-EXCISION-FACIAL-NERVE-PRESERVATION

CPT 42415: Excision of Lateral Parotid Lobe with Facial Nerve Preservation

CPT-42408-RANULA-EXCISION-FLOOR-OF-MOUTH

CPT 42408: Excision of Ranula, Floor of Mouth

CPT-42425-PAROTID-GLAND-REMOVAL-EN-BLOC-WITHOUT-FACIAL-NERVE-PRESERVATION

CPT 42425: Parotid Gland Removal with Tumor, No Facial Nerve Preservation

CPT-42440-SUBMANDIBULAR-GLAND-EXCISION

CPT 42440: Submandibular Gland Excision

Taxonomy Code	Specialty	Notes
207Y00000X	Otolaryngology (ENT)	Common specialty performing salivary gland biopsies.
2080P0221X	General Surgery	Surgeons may perform salivary gland needle biopsies, especially in operative settings.
207X00000X	Oral and Maxillofacial Surgery	Performs biopsies of salivary gland region in select clinical contexts.
364A00000X	Pathology & Clinical Laboratory	Provides definitive cytologic/histologic analysis of biopsy specimens.
2086S0123X	Radiology – Diagnostic	Interventional radiologists or radiologists may perform image-guided salivary gland biopsies.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`K11.5`	Sialadenitis	Inflammation of salivary gland that may prompt biopsy if mass or persistent abnormality is present.
`K11.6`	Sialolithiasis	Salivary gland stone disease; biopsy may be performed if a mass persists or malignancy is suspected.
`C07`	Malignant neoplasm of parotid gland	Primary concern when a suspicious salivary gland mass is present; biopsy is performed to establish diagnosis.
`D11.0`	Benign neoplasm of major salivary glands	Common indication for biopsy to characterize a palpable mass.
`R22.1`	Localized swelling, mass and lump, neck	Non-specific presenting sign that often prompts imaging and biopsy of salivary glands.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`10021`	Fine needle aspiration without imaging guidance	Alternative technique for salivary gland sampling when imaging guidance is not used.
`10022`	Fine needle aspiration with imaging guidance	Used when ultrasound or CT guidance is used to target the salivary gland lesion during aspiration.
`76882`	Ultrasound, soft tissue of head and neck, real-time with image documentation	Commonly performed immediately before or during the biopsy for lesion localization and guidance.
`49405`	Tissue harvest and diagnostic procedure	Used in some contexts for obtaining tissue for diagnosis; may be reported when larger core samples are obtained (facility-dependent).
`88305`	Level IV surgical pathology, gross and microscopic exam	Typical pathology CPT for histologic evaluation of salivary gland core biopsy specimens.

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