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CPT 42405: Open Salivary Gland Biopsy with Pathology

Headline: CPT code 42405: Open Salivary Gland Biopsy Sent for Pathology

Lead: CPT code 42405 denotes an open salivary gland biopsy performed through a skin incision directly over the gland with tissue submitted for pathological examination. The code captures a surgical diagnostic procedure used in evaluation of salivary gland masses or unexplained glandular dysfunction.

What the code represents and why it matters: CPT code 42405 documents an operative biopsy of a salivary gland via external incision. This procedure is clinically important because it provides definitive tissue diagnosis for neoplastic, inflammatory, or obstructive salivary gland conditions. Nationally, accurate coding affects claims adjudication, quality reporting, and procedure-level utilization tracking for head and neck surgical services.

Key payers covered: Analysis typically includes major national payers such as Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare.

What readers will learn: Readers will find a concise overview of the clinical context for CPT code 42405, typical sites of service, and the types of benchmarks and policy topics that typically accompany procedural code reviews (reimbursement patterns, documentation requirements, and coding guidance). Data not available in the input for specific reimbursement rates, payer-specific rules, associated taxonomies, and ICD-10 pairings are noted as not provided. The summary is intended for clinicians, billing professionals, and policy analysts seeking a national-level reference for this surgical biopsy code.

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Billing Code Overview

CPT code 42405 describes an open surgical procedure in which the provider obtains tissue samples from a salivary gland through a skin incision directly over the gland and sends the specimens for pathological analysis. This service is a salivary gland biopsy via external incision.

Service type: Surgical biopsy / operative procedure

Typical site of service: Operating room or outpatient surgery center, or other procedural settings where minor open head and neck surgery is performed.

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CPT 42405: Open Salivary Gland Biopsy with Pathology

Headline: CPT code 42405: Open Salivary Gland Biopsy Sent for Pathology

Key payers covered: Analysis typically includes major national payers such as Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare.

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Get alerted when payer policies referencing 42405 are released or updated.

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Billing Code Overview

Service type: Surgical biopsy / operative procedure

Typical site of service: Operating room or outpatient surgery center, or other procedural settings where minor open head and neck surgery is performed.

Clinical & Coding Specifications

Clinical Context

A 52-year-old patient presents to an outpatient otolaryngology clinic with a palpable, slowly enlarging, firm mass in the region of the parotid gland, intermittent local discomfort, and recent focal facial paresthesia. Imaging with ultrasound or MRI demonstrates a discrete salivary gland lesion suspicious for neoplasm. The patient is scheduled for an excisional or incisional salivary gland biopsy performed under local anesthesia with a small skin incision directly over the gland. The provider obtains representative tissue samples and sends them for histopathological examination, including routine H&E and, if indicated, immunohistochemical stains. Typical workflow: preoperative consent and brief history/physical, marking and sterile preparation of the surgical site, administration of local anesthesia (or monitored anesthesia care if indicated), skin incision and dissection to the salivary gland, tissue sampling (partial excision or core of lesion), hemostasis, layered closure of the incision, postoperative instructions, and specimen submission with pathology requisition.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services	Use when the procedure required substantially greater work than typical (extensive dissection, prolonged operative time).
`23`	Unusual anesthesia	Use when general anesthesia is medically necessary for a procedure that is normally performed with local/regional anesthesia.
`26`	Professional component	Use when reporting only the professional interpretation component of a related diagnostic service (rare for this surgical procedure).
`50`	Bilateral procedure	Use when the same salivary gland procedure is performed on both right and left sides during the same operative session.
`52`	Reduced services	Use when the procedure is partially reduced or not completed as originally planned.
`53`	Discontinued procedure	Use when the procedure is started but discontinued due to extenuating circumstances or patient condition.
`59`	Distinct procedural service	Use to indicate a separate, distinct procedure when multiple services are billed on the same day and not typically bundled.
`62`	Two surgeons	Use when two surgeons work together as primary surgeons performing distinct portions of the procedure.
`76`	Repeat procedure by same physician	Use when the same physician repeats the procedure later the same day.
`77`	Repeat procedure by another physician	Use when a second physician repeats the same procedure later the same day.
`78`	Return to the operating room for a related procedure during the postoperative period	Use when the patient returns to the OR for a complication related to the initial procedure.
`79`	Unrelated procedure or service by the same physician during the postoperative period	Use when an unrelated procedure is performed during the global period.
`26`	Professional component	Use when only the professional portion of an associated diagnostic test is reported.

Taxonomy Code	Specialty	Notes
207VF0000X	Otolaryngology	Most common specialty performing salivary gland biopsies and minor salivary surgery.
207VH0000X	Oral and Maxillofacial Surgery	Performs salivary gland and submandibular procedures when oral/maxillofacial approach is indicated.
2080P0221X	General Surgery	May perform salivary gland procedures in some settings, especially head and neck-focused general surgeons.
2084P0800X	Plastic Surgery	Performs reconstructive approaches for facial incisions or complex closures when indicated.
207K00000X	Diagnostic Radiology	May perform image-guided core biopsy of salivary lesions when listed as percutaneous approach.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`K11.3`	Sialadenitis	Inflammation of salivary gland that may require biopsy when chronic or when mass-like changes are present.
`K11.5`	Sialadenosis	Noninflammatory enlargement of salivary gland; biopsy may be performed if diagnosis uncertain.
`D11.0`	Benign neoplasm of parotid gland	Common indication to biopsy or excise suspicious salivary gland masses.
`C07`	Malignant neoplasm of parotid gland	Biopsy required for histologic diagnosis and treatment planning.
`K11.8`	Other specified diseases of salivary glands	Includes cysts or other localized lesions requiring tissue diagnosis.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`42400`	Exploratory operation on salivary gland	Related operative exploration when more extensive gland evaluation or excision is required beyond biopsy.
`42410`	Excision of salivary gland tumor (partial or superficial)	Performed when biopsy results indicate need for tumor excision; definitive surgical treatment following diagnostic biopsy.
`42320`	Excision of lesion of floor of mouth (for minor salivary gland lesions)	Related when minor salivary gland lesions in the oral cavity require excision rather than gland biopsy.
`10021`	Fine needle aspiration without imaging guidance	A less invasive diagnostic alternative often performed prior to open biopsy for cytologic diagnosis.
`76942`	Ultrasonic guidance for needle placement (eg, biopsy)	Used when image guidance (ultrasound) assists in localization for percutaneous or targeted sampling of salivary lesions.

CPT 42400: Percutaneous Salivary Gland Biopsy

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

CPT 42408: Excision of Ranula, Floor of Mouth

CPT-42409-MARSUPIALIZATION-SUBLINGUAL-SALIVARY-CYST

CPT 42409: Marsupialization of Sublingual Salivary Cyst

CPT-42410-PAROTID-LATERAL-LOBE-TUMOR-EXCISION-NO-NERVE-DISSECTION

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

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

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

CPT-42420-PAROTIDECTOMY-FACIAL-NERVE-PRESERVATION

CPT 42420: Parotidectomy with Facial Nerve Dissection and Preservation

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

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

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

CPT 42426: Total Parotidectomy with Unilateral Radical Neck Dissection

CPT-42440-SUBMANDIBULAR-GLAND-EXCISION

CPT 42440: Submandibular Gland Excision

CPT-42450-SUBLINGUAL-GLAND-EXCISION

CPT 42450: Sublingual Gland Excision

Frequently Asked Questions

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Jul 29, 2026.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Jul 29, 2026.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Jul 29, 2026.

Published by

Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services	Use when the procedure required substantially greater work than typical (extensive dissection, prolonged operative time).
`23`	Unusual anesthesia	Use when general anesthesia is medically necessary for a procedure that is normally performed with local/regional anesthesia.
`26`	Professional component	Use when reporting only the professional interpretation component of a related diagnostic service (rare for this surgical procedure).
`50`	Bilateral procedure	Use when the same salivary gland procedure is performed on both right and left sides during the same operative session.
`52`	Reduced services	Use when the procedure is partially reduced or not completed as originally planned.
`53`	Discontinued procedure	Use when the procedure is started but discontinued due to extenuating circumstances or patient condition.
`59`	Distinct procedural service	Use to indicate a separate, distinct procedure when multiple services are billed on the same day and not typically bundled.
`62`	Two surgeons	Use when two surgeons work together as primary surgeons performing distinct portions of the procedure.
`76`	Repeat procedure by same physician	Use when the same physician repeats the procedure later the same day.
`77`	Repeat procedure by another physician	Use when a second physician repeats the same procedure later the same day.
`78`	Return to the operating room for a related procedure during the postoperative period	Use when the patient returns to the OR for a complication related to the initial procedure.
`79`	Unrelated procedure or service by the same physician during the postoperative period	Use when an unrelated procedure is performed during the global period.
`26`	Professional component	Use when only the professional portion of an associated diagnostic test is reported.

Taxonomy Code	Specialty	Notes
207VF0000X	Otolaryngology	Most common specialty performing salivary gland biopsies and minor salivary surgery.
207VH0000X	Oral and Maxillofacial Surgery	Performs salivary gland and submandibular procedures when oral/maxillofacial approach is indicated.
2080P0221X	General Surgery	May perform salivary gland procedures in some settings, especially head and neck-focused general surgeons.
2084P0800X	Plastic Surgery	Performs reconstructive approaches for facial incisions or complex closures when indicated.
207K00000X	Diagnostic Radiology	May perform image-guided core biopsy of salivary lesions when listed as percutaneous approach.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`K11.3`	Sialadenitis	Inflammation of salivary gland that may require biopsy when chronic or when mass-like changes are present.
`K11.5`	Sialadenosis	Noninflammatory enlargement of salivary gland; biopsy may be performed if diagnosis uncertain.
`D11.0`	Benign neoplasm of parotid gland	Common indication to biopsy or excise suspicious salivary gland masses.
`C07`	Malignant neoplasm of parotid gland	Biopsy required for histologic diagnosis and treatment planning.
`K11.8`	Other specified diseases of salivary glands	Includes cysts or other localized lesions requiring tissue diagnosis.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`42400`	Exploratory operation on salivary gland	Related operative exploration when more extensive gland evaluation or excision is required beyond biopsy.
`42410`	Excision of salivary gland tumor (partial or superficial)	Performed when biopsy results indicate need for tumor excision; definitive surgical treatment following diagnostic biopsy.
`42320`	Excision of lesion of floor of mouth (for minor salivary gland lesions)	Related when minor salivary gland lesions in the oral cavity require excision rather than gland biopsy.
`10021`	Fine needle aspiration without imaging guidance	A less invasive diagnostic alternative often performed prior to open biopsy for cytologic diagnosis.
`76942`	Ultrasonic guidance for needle placement (eg, biopsy)	Used when image guidance (ultrasound) assists in localization for percutaneous or targeted sampling of salivary lesions.

CPT 42400: Percutaneous Salivary Gland Biopsy

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

CPT 42408: Excision of Ranula, Floor of Mouth

CPT-42409-MARSUPIALIZATION-SUBLINGUAL-SALIVARY-CYST

CPT 42409: Marsupialization of Sublingual Salivary Cyst

CPT-42410-PAROTID-LATERAL-LOBE-TUMOR-EXCISION-NO-NERVE-DISSECTION

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

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

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

CPT-42420-PAROTIDECTOMY-FACIAL-NERVE-PRESERVATION

CPT 42420: Parotidectomy with Facial Nerve Dissection and Preservation

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

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

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

CPT 42426: Total Parotidectomy with Unilateral Radical Neck Dissection

CPT-42440-SUBMANDIBULAR-GLAND-EXCISION

CPT 42440: Submandibular Gland Excision

CPT-42450-SUBLINGUAL-GLAND-EXCISION

CPT 42450: Sublingual Gland Excision

Frequently Asked Questions

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Jul 29, 2026.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Jul 29, 2026.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Jul 29, 2026.

Published by

Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.

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CPT 42405: Open Salivary Gland Biopsy with Pathology

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Billing Code Overview

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Billing Code Overview

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

References

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

References

CPT 42405: Open Salivary Gland Biopsy with Pathology

Sign up for cpt 42405 policy alerts

Billing Code Overview

CPT 42405: Open Salivary Gland Biopsy with Pathology

Sign up for cpt 42405 policy alerts

Billing Code Overview

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

What clinical procedure does CPT 42405 represent and where is it typically performed?

What does the typical workflow and specimen processing include for this procedure?

Which modifiers are commonly noted as relevant for CPT 42405?

What related CPT codes should be considered in the diagnostic or treatment pathway?

Which specialties typically perform CPT 42405 and which payers are referenced in the summary?

References

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

What clinical procedure does CPT 42405 represent and where is it typically performed?

What does the typical workflow and specimen processing include for this procedure?

Which modifiers are commonly noted as relevant for CPT 42405?

What related CPT codes should be considered in the diagnostic or treatment pathway?

Which specialties typically perform CPT 42405 and which payers are referenced in the summary?

References