Summary & Overview
CPT 42440: Submandibular Gland Excision
CPT code 42440 denotes the surgical excision of a submandibular gland, a definitive operative intervention for conditions such as chronic sialadenitis, obstructive salivary disease, or suspected glandular neoplasm. Nationally, this code captures a focused head-and-neck surgical service commonly performed in hospital operating rooms and ambulatory surgery centers and is relevant for surgical quality measurement, hospital resource planning, and outpatient surgical scheduling.
Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context for when the procedure is performed, typical sites of service, common billing considerations, and the payers included in the coverage review. The publication provides benchmarks for utilization and reimbursement patterns where available, recent policy or coverage updates affecting surgical authorization and site-of-service decisions, and coding considerations to support accurate claim submission.
This summary is intended for clinicians, coding professionals, and health plan analysts seeking a national-level briefing on the use and administrative implications of CPT code 42440 in surgical practice and payer interactions.
Billing Code Overview
CPT code 42440 describes the surgical removal of a submandibular gland. The service is a surgical procedure performed to excise one or both submandibular salivary glands, typically for indications such as chronic infection, obstructive sialadenitis, neoplasm, or symptomatic gland dysfunction.
Service Type: Surgical — Head and Neck / Otolaryngology
Typical Site of Service: Hospital operating room or ambulatory surgery center, with possible performance in an outpatient surgical suite depending on clinical and facility factors.
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult presenting with chronic submandibular gland swelling, recurrent sialadenitis, or a radiopaque salivary stone causing obstructive symptoms. Evaluation includes history, physical exam noting a firm or tender submandibular mass, ultrasound or CT to identify gland enlargement or sialolithiasis, and needle aspiration or culture if infection is suspected. When conservative measures (hydration, sialogogues, antibiotics, or gland-sparing endoscopic stone removal) are unsuccessful or not feasible, the surgeon schedules a definitive operative excision of the submandibular gland.
The procedure is performed in an operating room or ambulatory surgical center under general anesthesia with or without regional nerve monitoring. The workflow includes preoperative informed consent, pre-op antibiotics per facility protocol, patient positioning with a submandibular skin crease incision, meticulous dissection to identify and preserve the marginal mandibular branch of the facial nerve and lingual nerve, ligation of the facial artery and Wharton duct, gland removal, hemostasis, layered closure, and recovery monitoring. Postoperative care includes pain control, wound care instructions, short course antibiotics if indicated, and follow-up to assess nerve function and wound healing.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
11 | Normal, uncomplicated service | When the procedure is performed without unusual circumstances or complications beyond typical expectations |