Summary & Overview
CPT 42650: Insertion of Probe for Salivary Duct Dilation
CPT code 42650 represents insertion of a probe to dilate the salivary duct, a targeted minor interventional procedure used to address obstructive salivary duct conditions. Nationally, this code captures episodic procedural care for patients with sialolithiasis, ductal stenosis, or other causes of salivary duct obstruction and is relevant to outpatient surgical, ambulatory, and office-based care pathways.
Key payers included in the analysis are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context and service settings, typical payer coverage considerations, and benchmarking topics commonly reviewed for procedural codes of this type.
The publication summarizes how 42650 is used in clinical practice, where it is typically performed, and what stakeholders monitor for reimbursement and utilization trends. It highlights areas for coder and revenue cycle attention, and points readers to sections covering modifiers, payer-specific policies, and related procedural codes. Data not available in the input are noted where applicable.
Billing Code Overview
CPT code 42650 describes a procedure in which the provider inserts a probe to dilate the salivary duct. This is a minor interventional procedure performed to relieve or evaluate obstructive conditions of the salivary ductal system.
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Service type: Ductal dilation procedure of the salivary gland
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Typical site of service: Ambulatory surgical center, hospital outpatient department, or office procedure setting depending on clinical complexity and facility capabilities
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult presenting to an otolaryngology clinic with recurrent painful swelling of the submandibular or parotid region, especially at mealtimes, and symptoms consistent with sialadenitis or suspected sialolithiasis obstructing a major salivary duct. The workflow begins with history and focused exam, salivary gland imaging (ultrasound or sialography) as needed, and topical or local anesthesia. The provider performs duct probing and dilation using a sterile probe to relieve obstruction or to allow subsequent irrigation, stone retrieval, or endoscopic access. The procedure is often performed in an office procedure room or ambulatory surgery center under local anesthesia with or without sedation. Typical documentation includes indication, informed consent, anesthesia type, laterality, procedure steps (probe insertion, dilation method, any irrigation or stone removal), estimated blood loss (usually minimal), complications (if any), and post-procedure instructions for gland massage and hydration.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | Use when billing only the physician’s professional work distinct from technical facility charges. |
50 | Bilateral procedure |