Loading...

    Explore
    • Policy Monitoring
    • Live Policy Feed
    • Billing Codes
    • Healthcare Providers
    • Health Insurance Payers
    • States
    • Service Lines
    • Taxonomy Codes
    Lookup tools
    • Billing Code Lookup
    • CPT Modifier Lookup
    • Provider Taxonomy Code Lookup
    • Healthcare Provider & Facility Lookup
    • Health Insurance Payer Lookup
    • Payer Contact Directory

    Policy & Benchmark Tools

    • Prior Authorization Lookup
    • Coverage Criteria Lookup
    • Timely Filing Lookup
    • Billing Code Reimbursement Rates
    • Payer Comparison Dashboard
    • Facility Comparison Dashboard
    • All tools

    Company

    • About OpenPayer
    • Data Sources
    • Trek Health
    OpenPayerby Trek Health
    LinkedInYouTube

    © 2026 Trek Health. All rights reserved.

    OpenPayer is built and maintained by Trek Health.

    v1.0.30
    OpenPayerBilling CodesRepair Procedures on the Salivary Gland and DuctsCPT cpt-42510-parotid-duct-rerouting-whartons-duct-ligation-sialorrhea
    Ask Trek AI about this page

    CPT 42510: Parotid Duct Rerouting with Submandibular Duct Ligation

    Medicare pays $550 on average nationally for this procedure.

    CPT code 42510 describes a Wilke-type procedure (parotid duct rerouting) with ligation of both submandibular (Wharton's) ducts, a surgical treatment for sialorrhea (drooling); the service is an operative salivary gland rerouting/ligation typically performed in an inpatient or outpatient surgical setting such as an operating room under general anesthesia to address refractory drooling when conservative measures have failed.

    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]).

    Customize your policy alerts

    Sign up for cpt 42510 policy alerts

    Get alerted when payer policies referencing 42510 are released or updated.

    Monitor payer policy activity

    Receive email alerts as soon as relevant payer policies are published or updated.

    Table of contents

    Progress1 / 7

    Explore openpayer tools

    • Billing CodesCPT, HCPCS, DRG & more
    • Reimbursement RatesCommercial vs. Medicare rate reports
    • Facility ComparisonBeds, revenue & payer mix
    • ProvidersHospitals & facilities
    • PayersPlans & market footprint
    • Taxonomy CodesNUCC specialty codes
    • ModifiersCPT modifiers & usage
    • Prior AuthorizationPA policies by payer & drug
    • Timely FilingFiling deadlines by payer
    • Coverage CriteriaMedical necessity by payer
    • Payer ContactsClaims, PA & appeals contacts
    View all tools

    Clinical & Coding Specifications

    Clinical Context

    A typical patient is a pediatric or adult patient with severe, refractory sialorrhea (excessive drooling) causing aspiration risk, perioral skin breakdown, social impairment, or hygiene issues. The patient often has an underlying neurologic disorder such as cerebral palsy, amyotrophic lateral sclerosis, Parkinson disease, or traumatic brain injury resulting in impaired oral motor control. Prior conservative treatments—behavioral therapy, anticholinergic medications, and botulinum toxin injections into the salivary glands—have failed or produced unacceptable side effects.

    Preoperative evaluation includes a focused history and physical, assessment of swallowing and aspiration risk, review of prior treatments, and imaging or sialography when duct anatomy is unclear. The operative plan for 42510 (Wilkie procedure / parotid duct rerouting with bilateral ligation of submandibular ducts) is typically performed under general anesthesia in an operating room. The procedure reroutes parotid ducts to the oropharynx and ligates both submandibular (Wharton's) ducts to reduce submandibular saliva flow, thereby decreasing anterior drooling.

    Postoperative care includes airway monitoring, swallow evaluation, short inpatient observation or same-day discharge depending on comorbidity, analgesia, wound care, and instructions regarding oral intake. Potential complications documented in the clinical workflow that affect coding and billing include infection, ductal stenosis, xerostomia, gustatory sweating, transient facial nerve weakness, and need for revision surgery. Documentation should include indication, prior therapies, informed consent, laterality, intraoperative findings, any concurrent procedures, and postoperative plan to support 42510 medical necessity and level of service.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    30520Excision or transposition of salivary duct, parotid duct; unilateralUsed when parotid duct rerouting/transposition is performed on a single side as part of or in addition to 42510 maneuvers
    42440Excision of salivary gland, submandibular, partial or completeRelated when submandibular gland excision is performed instead of or in conjunction with duct ligation for sialorrhea management
    42600Sialolithotomy, excision of salivary calculus; submandibularPerformed when obstructing calculi are encountered or removed during access to Wharton duct
    43280Endoscopic procedures of the salivary duct (sialendoscopy)Used for diagnostic or therapeutic ductal evaluation and may precede or accompany definitive rerouting/ligation procedures
    99100Anesthesia complicated or unusual monitoringUsed to report unusual anesthesia complexity when documented (adjunct to surgical coding)

    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…
    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…
    63Modifier‑63 is appended to surgical CPT codes (20000–69990) when a procedure is performed on a neonate or infant weighing ≤ 4 kg (about 8.8 lbs). The AMA/AAPC definition specifies this use and notes…- Use modifier -63 only for surgical procedures in the CPT 20000–69990 series performed on a neonate or infant who weighs ≤ 4 kg at the time of the procedure; it indicates increased complexity due to…
    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
    2084P0800X
    207R00000X
    208000000X
    261QP2300X
    246QC2700X
    225X00000X
    106S00000X
    246QH0000X

    Related ICD-10-CM Codes

    27 rows

    ICD-10-CM CodeDescription
    F02.80Dementia in other diseases classified elsewhere, unspecified severity, without behavioral disturbance, psychotic disturbance, mood disturbance, and anxiety
    F03.90Unspecified dementia, unspecified severity, without behavioral disturbance, psychotic disturbance, mood disturbance, and anxiety
    F84.0Autistic disorder
    G31.84Mild cognitive impairment of uncertain or unknown etiology
    G51.8Other disorders of facial nerve
    G51.9Disorder of facial nerve, unspecified
    I69.391Dysphagia following cerebral infarction
    I69.398Other sequelae of cerebral infarction
    K11.6Mucocele of salivary gland
    K11.7Disturbances of salivary secretion

    Showing 1–10 of 27

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

    CPT 42509: Parotid Duct Rerouting with Bilateral Submandibular Excision

    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.
    Published by

    Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.

    Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.