Summary & Overview

CPT 42699: Salivary Gland/Duct Procedure, Unlisted

CPT code 42699 designates unlisted procedures on the salivary glands or ducts, used when a specific CPT code does not describe the performed service — for example, salivary gland endoscopy to remove stones or ductal obstructions. Nationally, this code matters because it captures uncommon or emerging salivary gland interventions that fall outside standard code sets, affecting billing clarity and claim adjudication for otolaryngology and oral maxillofacial surgical services.

Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise policy and clinical context for CPT code 42699, including common use cases, typical sites of service, and the implications of using an unlisted CPT code for documentation and claim presentation. The publication outlines expected content of supporting documentation, common payer considerations, and how CPT code 42699 fits into procedure coding workflows for salivary gland interventions.

This summary equips billing managers, clinicians, and policy analysts with a clear understanding of when CPT code 42699 is used, why accurate documentation matters for national claim processing, and what to expect in coder and payer interactions. Data not available in the input for payer-specific rates, taxonomies, ICD-10 mappings, and related codes.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareCPT 42699salivary gland procedureunlisted CPTENT surgerysialendoscopyambulatory surgerybilling guidanceprocedure codingclaim documentation

Billing Code Overview

CPT code 42699 is an unlisted procedure code for procedures on the salivary glands or ducts not described by other codes. Typical examples include salivary gland endoscopy for removal of salivary stones and other ductal obstructions when no specific code exists.

Service type: Surgical procedure on salivary glands/ducts, often minimally invasive endoscopic or operative removal of obstructions
Typical site of service: Ambulatory surgical center or hospital outpatient department; selected cases may occur in inpatient settings depending on clinical complexity

Clinical & Coding Specifications

Clinical Context

A typical patient is an adult presenting to an otolaryngology clinic with recurrent unilateral submandibular gland swelling, intermittent painful salivary flow, and a history of sialolithiasis. Diagnostic workup includes history, physical exam with palpation of the floor of mouth and duct, and imaging such as ultrasound or non-contrast CT showing a ductal or intraglandular salivary stone or stricture. Conservative measures (hydration, sialagogues, gland massage, antibiotics for acute infection) are attempted first. When conservative care fails or imaging demonstrates an obstructing stone not amenable to blind extraction, the patient is scheduled for a salivary gland endoscopy (sialendoscopy) and stone removal under local with sedation or general anesthesia depending on stone size and location.

Typical workflow:

Pre-procedure: surgical consent, imaging review, pre-anesthesia evaluation if general anesthesia planned, and documentation of prior conservative treatments and failed extraction attempts.
Procedure: sterile field in an ambulatory surgery center or hospital OR, dilation of the salivary duct orifice, insertion of a sialendoscope, visualization of the ductal system, identification and retrieval or fragmentation of the stone (wire basket, microforceps, or laser), irrigation, possible stent placement for ductal patency, and hemostasis.
Post-procedure: recovery monitoring, discharge with sialagogue instructions, analgesia, and follow-up to assess gland function and wound healing. Complications documented may include ductal injury, infection, bleeding, or transient numbness.

Typical site of service: ambulatory surgery center (ASC), hospital outpatient department (HOPD), or occasionally office-based procedure suite depending on complexity and anesthesia.

Service type: diagnostic/therapeutic salivary gland endoscopy and stone/obstruction removal performed by otolaryngology-head & neck surgeons (or oral and maxillofacial surgeons) using specialized endoscopic instruments; reported with 42699 when no specific CPT code accurately describes the performed salivary gland/duct procedure.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services	Use when work required to perform the procedure is substantially greater than typical, documented with rationale and time.
`26`	Professional component	Use when reporting only the professional component of a diagnostic endoscopic service split with a facility or technical component billed separately.
`50`	Bilateral procedure	Use when identical salivary gland procedures are performed on both left and right glands and payer requires bilateral modifier reporting.
`52`	Reduced services	Use when the procedure is partially reduced or not completed as planned and documentation supports partial performance.
`53`	Discontinued procedure	Use when the procedure is started but terminated due to extenuating circumstances prior to completion; include reason in record.
`62`	Two surgeons	Use when two surgeons work together as primary surgeons performing distinct portions of the procedure.
`66`	Surgical team	Use when a surgical team performs distinct components of a complex procedure requiring team approach.
`78`	Return to OR for related procedure during postoperative period (unplanned)	Use when a patient returns to the OR for a related procedure due to complication during the global period.
`79`	Unrelated procedure during postoperative period	Use when an additional procedure unrelated to the original surgery is performed during the global period.
`AS`	Physician assistant, nurse practitioner, or clinical nurse specialist billing under specific state rules	Use when an eligible non-physician practitioner performs or assists and payer recognizes `AS` for anesthesiology services or facility rules require.
`LT`	Left side	Use to indicate the procedure was performed on the left salivary gland/duct when laterality is required.
`RT`	Right side	Use to indicate the procedure was performed on the right salivary gland/duct when laterality is required.
`XU`	Unusual non-overlapping service	Use when reporting a service that is distinct and separate from other services provided on the same day (use per payer rules and with documentation).

Taxonomy Code	Specialty	Notes
207Y00000X	Otolaryngology	Primary specialty performing sialendoscopy and salivary gland procedures.
1223P0001X	Oral and Maxillofacial Surgery	Performs salivary gland and duct procedures, particularly when access or jaw-related factors involved.
2086S0122X	Head and Neck Surgery	Subspecialist within otolaryngology managing complex salivary gland disease.
208C00000X	Surgery	General surgeons may perform salivary procedures in some settings; included as less common provider taxonomy.

CPT Code	Description	Relationship to This Procedure
`42440`	Excision of submandibular gland (complete)	Performed when sialendoscopy fails or gland disease (chronic infection, neoplasm) requires gland excision after failed stone removal.
`42820`	Excision of parotid gland, partial	Related when parotid duct or intraglandular disease requires open surgical management instead of endoscopic approach.
`40490`	Dilation of salivary duct with insertion of catheter	Often performed as an adjunct or alternative to sialendoscopy for ductal strictures or small distal stones.
`69990`	Endoscopic procedures, not otherwise classified; salivary gland endoscopy when no specific code applies	Sometimes used as an unlisted endoscopic code for novel instrumentation or approaches if payer does not accept `42699`.
`36415`	Collection of venous blood by venipuncture	Common ancillary service performed preoperatively for labs and anesthesia clearance prior to the procedure.

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