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    OpenPayerBilling CodesRepair Procedures on the Salivary Gland and DuctsCPT cpt-42507-parotid-duct-rerouting-wilke-procedure
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    CPT 42507: Wilke-Type Parotid Duct Rerouting Procedure

    Medicare pays $453 on average nationally for this procedure.

    CPT code 42507 describes a Wilke-type procedure (parotid duct rerouting) performed to treat sialorrhea (drooling); the service is a surgical salivary gland/duct rerouting procedure typically performed in an operating room or ambulatory surgical center under general anesthesia and involves repositioning the parotid duct to reduce anterior oral secretions.

    For related coverage guidance, see recent payer policy updates: Orthopedic Joint Procedures of the Knee for Managed Medicaid (MMC), Health and Recovery Plan (HARP), Child Health Plus (CHP), and Essential Plan (EP) Members, Autologous Chondrocyte Transplantation or Implantation Corporate Medical Policy, Autologous Platelet-Derived Growth Factors (Platelet-Rich Plasma [PRP]).

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    Clinical & Coding Specifications

    Clinical Context

    A typical patient is a pediatric or adult patient with medically significant sialorrhea (drooling) that has failed conservative management (behavioral therapy, anticholinergic medications, botulinum toxin injections). The patient presents to an otolaryngology (ENT) clinic with social, dermatologic, or aspiration-related complications from chronic drooling. Preoperative evaluation includes history, physical exam focusing on salivary gland function and duct anatomy, and counseling regarding risks (xerostomia, duct obstruction, facial nerve injury, wound complications). Imaging such as ultrasound or sialography may be obtained selectively. The procedure is performed in an operating room or ambulatory surgical center under general anesthesia. The surgeon performs a parotid duct rerouting (Wilke-type) to redirect saliva flow away from the oral vestibule, reducing anterior drooling. Postoperative care includes short inpatient observation or same-day discharge, pain control, oral hygiene instructions, and follow-up to monitor healing and functional outcomes. Indications commonly include neurodevelopmental disorders (cerebral palsy), progressive neurodegenerative conditions, or refractory sialorrhea impacting quality of life or airway safety.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    42810Sialendoscopy, diagnostic, with or without irrigation, with or without collection of specimenDiagnostic evaluation of salivary ductal anatomy prior to or at the time of salivary procedures; may identify obstruction or guide intervention.
    42420Excision of accessory parotid glandPerformed when accessory gland tissue contributes to symptoms and is removed during surgical management of sialorrhea.
    42440Excision of deep lobe of parotid glandPerformed for pathology involving the deep lobe or when more extensive glandular resection is required.
    42630Excision of submandibular gland, transoralAlternative or adjunct salivary gland surgery when submandibular gland management is part of drooling treatment.
    64612Chemodenervation of salivary gland(s) (e.g., botulinum toxin)Often performed as a less invasive alternative or temporizing measure prior to considering 42507 for refractory drooling.
    99499Unlisted evaluation and management serviceUsed in some billing systems for atypical perioperative coordination when no specific code exists (facility-dependent).

    Related Modifiers

    13 rows

    ModifierDescriptionWhen to Use
    22Modifier –22 (Increased Procedural Services) is used when a reported procedure is substantially more extensive than normally required. The CPT Manual and CMS state it may be appended only when the…- When to use: Append modifier -22 to a procedural CPT code when the service performed is substantially more extensive than the usual service described by that code — i.e., the procedure required…
    23Modifier -23 (Unusual Anesthesia) is used on anesthesia service CPT codes when a procedure that normally requires no anesthesia or only local anesthesia must be performed under general anesthesia…- Use modifier -23 only on anesthesia CPT codes (00100–01999) when a procedure that normally requires no anesthesia or only local anesthesia must be performed under general anesthesia because of…
    26Modifier 26 (Professional Component) identifies and bills only the professional portion of a split service — the physician’s interpretation, report, and medical judgment — when the technical…- Use CPT Modifier -26 when you are billing only the professional component (PC) of a split‑bill eligible service—i.e., you performed the physician interpretation, medical judgment and prepared a…
    50Modifier –50 (Bilateral Procedure) is appended to a CPT code when an identical procedure is performed on paired anatomical structures during the same operative session. The AMA states to add…- Use modifier -50 when the same CPT surgical, diagnostic, or radiology procedure is performed on paired anatomical structures (both sides of the body) during the same operative/session by the same…
    51Modifier –51 (Multiple Procedures) is used when the same provider performs multiple procedures in the same session to identify secondary, non‑exempt procedures and indicate payment reduction logic…- Use modifier -51 when the same provider performs multiple distinct procedures during the same patient encounter: report the highest‑valued procedure first (no modifier) and append -51 to…
    52Modifier ‑52 (Reduced Services) indicates that a service or procedure was partially reduced or omitted at the provider’s discretion, allowing reporting of the basic procedure number with a qualifier…- Use modifier -52 when a physician or qualified health professional electively reduces or omits part of a procedure or service (for example, performing fewer required views or omitting a portion of…
    53Modifier 53 (Discontinued Procedure) signals that a surgical or diagnostic service was begun by the physician but terminated because of extenuating circumstances that threatened the patient’s…- Use modifier -53 when a physician/qualified healthcare professional has started a surgical or diagnostic procedure (e.g., anesthesia administered, incision or scope insertion) and then discontinues…
    62Modifier 62 indicates that two surgeons function as co‑surgeons, each performing distinct parts of the same primary surgical procedure. It is appended to the primary procedure code (and any…- Use modifier -62 when two surgeons act as co‑surgeons (both primary surgeons) on a single definitive primary procedure, each performing distinct parts of the same surgical procedure (append -62 to…
    66Modifier 66 (Surgical Team) is used when three or more surgeons act as primary surgeons on a single, highly complex procedure. The AMA defines it for use when a surgical team — often composed of…- Use modifier 66 when three or more surgeons act as primary surgeons working collaboratively as a surgical team on a single, highly complex or difficult procedure (for example organ…
    78CPT modifier -78 indicates an unplanned, related return to the operating or procedure room by the same provider during the global postoperative period. It is appended when treatment for a…- Use modifier -78 when an unplanned, related complication during the original procedure’s global postoperative period requires the patient to return to a formal operating or procedure room and the…

    Showing 1–10 of 13

    Related Provider Taxonomies

    8 rows

    Taxonomy Code
    207R00000X
    208000000X
    2084P0800X
    207K00000X
    364SN0000X
    207VB0002X
    3140N1450X
    207VG0400X

    Related ICD-10-CM Codes

    26 rows

    ICD-10-CM CodeDescription
    F02.80Dementia in other diseases classified elsewhere, unspecified severity, without behavioral disturbance, psychotic disturbance, mood disturbance, and anxiety
    F80.9Developmental disorder of speech and language, unspecified
    F82Specific developmental disorder of motor function
    G31.9Degenerative disease of nervous system, unspecified
    G80.0Spastic quadriplegic cerebral palsy
    G80.2Spastic hemiplegic cerebral palsy
    G80.9Cerebral palsy, unspecified
    G81.90Hemiplegia, unspecified affecting unspecified side
    G81.91Hemiplegia, unspecified affecting right dominant side
    K11.3Abscess of salivary gland

    Showing 1–10 of 26

    Related Payer Policy Updates

    Specialty: Orthopedics/Musculoskeletal1 / 3

    10 rows

    PolicyPayerEffective Date
    Orthopedic Joint Procedures of the Knee for Managed Medicaid (MMC), Health and Recovery Plan (HARP), Child Health Plus (CHP), and Essential Plan (EP) Membersuniverahealthcare2027-01-01
    Autologous Chondrocyte Transplantation or Implantation Corporate Medical Policybcbsvermont2026-12-01
    Autologous Platelet-Derived Growth Factors (Platelet-Rich Plasma [PRP])Cigna2026-10-15
    Metatarsophalangeal Joint ReplacementCigna2026-10-15
    Shoulder Arthroplasty (Total, Partial, Reverse, Revision and Resurfacing)univerahealthcare2026-10-15
    Hip Arthroplasty (partial and total hip replacement)univerahealthcare2026-10-15
    Artificial Lumbar Intervertebral Disc (Lumbar Total Disc Arthroplasty)univerahealthcare2026-10-15
    Osteochondral Grafting of the Kneeuniverahealthcare2026-10-15
    Lumbar Fusion (arthrodesis) with decompressionuniverahealthcare2026-10-15
    Metal-on-Metal Total Hip Resurfacinguniverahealthcare2026-10-15

    Related Codes

    CPT-42500-SALIVARY-GLAND-PRIMARY-SIMPLE-REPAIR

    CPT 42500: Repair of Infected or Damaged Salivary Gland

    CPT-42505-SECONDARY-COMPLICATED-SALIVARY-GLAND-REPAIR

    CPT 42505: Secondary or Complicated Repair of Salivary Gland

    CPT-42509-PAROTID-DUCT-REROUTING-SUBMANDIBULAR-GLAND-EXCISION

    CPT 42509: Parotid Duct Rerouting with Bilateral Submandibular Excision

    CPT-42510-PAROTID-DUCT-REROUTING-WHARTONS-DUCT-LIGATION-SIALORRHEA

    CPT 42510: Parotid Duct Rerouting with Submandibular Duct Ligation

    Frequently Asked Questions

    References

    1. 1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
    2. 2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
    3. 3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.
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