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    OpenPayerBilling CodesRepair Procedures on the Salivary Gland and DuctsCPT cpt-42509-parotid-duct-rerouting-submandibular-gland-excision
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    CPT 42509: Parotid Duct Rerouting with Bilateral Submandibular Excision

    Medicare pays $734 on average nationally for this procedure.

    CPT code 42509 describes a Wilke-type procedure (parotid duct rerouting) with excision of both submandibular glands, performed to address sialorrhea (drooling); this is a surgical head and neck procedure typically performed in an operating room or hospital outpatient surgical setting under general anesthesia for definitive management of excessive salivation.

    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 12-year-old child with severe neurodevelopmental disability and refractory sialorrhea is evaluated for surgical management after failed conservative measures (behavioral therapy, anticholinergic medication, botulinum toxin injections). The multidisciplinary team includes pediatric otolaryngology, speech-language pathology, and anesthesia. Preoperative assessment documents frequent aspiration events, skin breakdown around the mouth, and social impairment from drooling. Imaging and physical exam confirm salivary gland anatomy appropriate for a Wilke-type procedure.

    The operative plan is a parotid duct rerouting with excision of both submandibular glands (CPT 42509) performed under general endotracheal anesthesia in an outpatient or short-stay hospital setting depending on comorbidities. Intraoperative steps include bilateral submandibular gland excision, identification and rerouting of the parotid (Stensen) ducts, hemostasis, and layered closure. Postoperative workflow includes PACU monitoring for airway compromise, pain control, swallow evaluation by speech therapy, and instruction for wound care. Expected disposition is same-day discharge for uncomplicated patients or overnight observation for those with respiratory or medical complexity. Follow-up is arranged at 1–2 weeks for wound check and 6–12 weeks for functional assessment of drooling reduction.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    42630Excision of submandibular gland, unilateralMay be used if only one submandibular gland is excised rather than bilateral when documenting laterality or staged procedures
    42633Excision of submandibular gland, bilateralAlternative code when both submandibular glands are excised without parotid duct rerouting; could be reported with or instead of CPT 42509 depending on services performed
    42820Ligation or transection of salivary ductPerformed when ductal interruption or ligation is chosen instead of or in addition to parotid duct rerouting
    42440Partial parotidectomy, primary, superficialMay be performed if parotid gland tissue requires excision during ductal rerouting or for concurrent pathology
    42800Sialolithotomy; intraoral, with removal of calculusPerformed when a salivary stone is encountered and removed during operative management of salivary disorders

    Related Modifiers

    11 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…
    59Modifier 59 indicates a distinct procedural service when two procedures that are not normally billed together are clinically and procedurally separate. The CPT definition (as reiterated by CMS)…- Use modifier -59 to report a distinct procedural service when documentation supports that the procedure reported is not normally billed together with another service on the same day because of a…
    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…
    73Modifier 73 indicates a facility-level outpatient hospital or ASC procedure that was discontinued after the patient was prepared and taken to the procedure/operating room but before any anesthesia…- When to use: Apply CPT modifier 73 on the FACILITY (outpatient hospital or ASC) claim when the patient has been fully prepared and physically taken into the procedure/operating room but the…
    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 11

    Related Provider Taxonomies

    8 rows

    Taxonomy Code
    207W00000X
    207L00000X
    208000000X
    2084P0800X
    2084N0400X
    261QP2300X
    283X00000X
    2080P0206X

    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-42507-PAROTID-DUCT-REROUTING-WILKE-PROCEDURE

    CPT 42507: Wilke-Type Parotid Duct Rerouting Procedure

    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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