Summary & Overview
CPT 42500: Primary or Simple Repair of Salivary Gland
CPT code 42500 denotes the primary or simple surgical repair of an infected or damaged salivary gland. This code is used to bill for operative procedures that remove or repair diseased salivary tissue to address infection, trauma, or functional impairment. Nationally, accurate coding for salivary gland repair matters for appropriate reimbursement, quality reporting, and utilization tracking for a relatively uncommon but clinically important head and neck procedure.
Key payers addressed in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of clinical context for salivary gland repair, common sites of service where the procedure is performed, and typical billing considerations. The publication summarizes available benchmarks and payer-specific coverage considerations when present, and flags areas where policy updates or coding clarifications may affect claims processing.
The report is intended to inform billing managers, surgical providers, and revenue cycle staff about the official code definition, expected service settings, and the payer mix most commonly relevant to claims for this procedure. Data not available in the input for specific modifiers, associated taxonomies, and ICD-10 diagnosis pairings is noted in the detailed sections.
Billing Code Overview
CPT code 42500 describes the primary or simple repair of an infected or damaged salivary gland. The service involves surgical intervention to address infection, trauma, or other damage to a salivary gland, typically performed to remove diseased tissue and restore gland function or relieve symptoms.
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Service type: Surgical repair of salivary gland (primary/simple repair)
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Typical site of service: Ambulatory surgery center or hospital operating room; procedures may also occur in outpatient surgical clinics depending on clinical need and facility capability.
Data not available in the input for associated taxonomies, ICD-10 diagnoses, and related codes.
Clinical & Coding Specifications
Clinical Context
A 48-year-old male presents to the otolaryngology clinic with a 5-day history of a painful, erythematous swelling along the anterior border of the mandible, purulent drainage from the ductal orifice of the submandibular gland, fever, and elevated white blood cell count. Conservative management with antibiotics and sialogogues failed and ultrasound demonstrated a focal abscess within the submandibular gland. The provider schedules the patient for operative management under monitored anesthesia care in an ambulatory surgery center. Intraoperatively, the surgeon performs a primary repair of the infected portion of the salivary gland and ductal tissue with incision and drainage of the abscess and layered closure of the glandular defect.
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Service Type: Minor operative procedure – primary/simple repair of salivary gland
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Typical Site of Service: Ambulatory surgery center or hospital outpatient surgical suite
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Clinical workflow: Preoperative evaluation and imaging (ultrasound/CT) → informed consent and preoperative antibiotics → intraoperative repair of gland and drainage of abscess → postoperative monitoring, pain control, and instruction for wound care and follow-up with ENT clinic.
Coding Specifications
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