Summary & Overview
CPT 42425: Parotid Gland Removal with Tumor, No Facial Nerve Preservation
CPT code 42425 denotes surgical excision of the parotid gland with a tumor removed as a single unit without preservation of the facial nerve. Nationally, this code is used for cases where tumor involvement or surgical planning precludes facial nerve-sparing approaches. It is relevant to surgical oncology, head and neck surgery, and facility billing for operative services.
Key payers included in the analysis are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of clinical context for the procedure, typical sites of service, and common billing constructs tied to this code. The publication summarizes benchmark considerations for payment and utilization, highlights policy and coverage factors that commonly affect reimbursement, and situates the code within operative care pathways for parotid tumors.
This executive summary is intended for a national audience of payers, providers, and billing professionals seeking concise information on coding, clinical context, and payer coverage patterns for CPT code 42425. Data not available in the input are noted where applicable in the detailed sections.
Billing Code Overview
CPT code 42425 describes the removal of the parotid gland with a tumor as a single unit without preservation of the facial nerve. This procedure is a surgical excision of the parotid gland performed when tumor involvement or operative planning necessitates removal of the gland en bloc without attempting to preserve the facial nerve.
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Service type: Surgical resection of the parotid gland for tumor removal
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Typical site of service: Inpatient or outpatient surgical setting, commonly performed in a hospital operating room or ambulatory surgical center depending on clinical complexity and institutional practice
Clinical & Coding Specifications
Clinical Context
A typical patient is a 62-year-old with a progressively enlarging, firm, non-tender mass in the tail of the parotid gland with imaging (ultrasound/CT/MRI) suspicious for primary salivary gland malignancy. Fine needle aspiration may be indeterminate or suggest malignant neoplasm. The surgical team schedules a radical parotidectomy with removal of the parotid gland and tumor en bloc without preservation of the facial nerve due to tumor encasement or direct invasion of the facial nerve. The operative workflow includes preoperative imaging review, informed consent discussing facial nerve sacrifice and expected facial paralysis, general anesthesia with nerve monitoring as applicable, wide exposure of the parotid region, careful oncologic resection of the gland and tumor as a single specimen, hemostasis, possible neck dissection if nodal disease is suspected, placement of drains, and postoperative recovery with plans for adjuvant radiotherapy if pathology confirms malignancy. Typical site of service is an inpatient or ambulatory hospital surgical suite for major head and neck oncologic surgery. Service type: major surgical oncology procedure of the head and neck.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier — standard reporting | Use when no specific modifier applies and standard global period and services are reported. |