Summary & Overview
CPT 42665: Intraoral Salivary Duct Ligation
CPT code 42665 represents an intraoral surgical procedure in which a clinician makes an incision inside the mouth to access and ligate a salivary duct. This procedure is used to treat conditions such as chronic sialorrhea, recurrent obstructive sialadenitis, or persistent salivary fistulae when ductal ligation is clinically indicated. Nationally, accurate coding for duct ligation affects surgical case classification, facility resource planning, and appropriate payment for oral and maxillofacial surgical services.
Key payers commonly referenced for coverage and reimbursement practice include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise explanation of the code’s clinical context and procedural setting, plus guidance on typical documentation elements required to support claims. The publication also provides benchmarking information and policy-relevant updates that influence coding and payment decisions for salivary duct procedures.
This summary is intended to inform coding professionals, surgical providers, and health plan policy staff about the clinical scope of CPT code 42665, typical sites of service, and the kinds of benchmarks and policy elements that affect claim adjudication and reimbursement.
Billing Code Overview
CPT code 42665 describes an intraoral incision to access a salivary duct with ligation (tying off) of the duct. The procedure involves making an incision inside the mouth to reach a salivary gland duct and performing ligation to obstruct flow from the gland.
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Service type: Surgical procedure on salivary duct (intraoral ligation)
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Typical site of service: Operative suite or ambulatory surgical center; performed intraorally under appropriate anesthesia
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult presenting with recurrent swelling and pain of the floor of mouth or submandibular gland attributable to chronic obstructive sialadenitis, sialolithiasis, or persistent salivary duct fistula. The patient often reports intermittent swelling that worsens with meals and may have documented stones on ultrasound or CT. After clinical evaluation, conservative measures (hydration, sialogogues, antibiotics if infected) are attempted. When obstruction persists or ductal injury/fistula requires definitive management, the oral surgeon or otolaryngologist schedules an intraoral procedure under local anesthesia with sedation or general anesthesia.
The procedure involves an intraoral incision to expose the affected salivary duct (typically the submandibular or sublingual duct), identification of the duct proximal to the obstruction or fistula tract, and ligation (tying off) of the duct to eliminate salivary flow through the damaged channel. Hemostasis is obtained and the mucosa is closed primarily. Postoperative workflow includes short observation, analgesia, oral hygiene instructions, and follow-up to monitor for infection, gland atrophy, or persistent symptoms. Typical site of service is an ambulatory surgery center or hospital outpatient department; minor cases may occur in an office procedure room depending on anesthesia level and facility capabilities.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | Unspecified |