CPT 42810 Brachial Cleft Cyst Reimbursement | OpenPayer

Summary & Overview

CPT 42810: Excision of Brachial Cleft Cyst

CPT code 42810 denotes the surgical excision of a brachial cleft cyst, a congenital lateral neck cyst resulting from incomplete closure of the second branchial cleft. This code matters nationally because these procedures address symptomatic infections, recurrent cysts, and cosmetic or functional concerns; accurate coding drives appropriate claims processing and care tracking across surgical specialties such as otolaryngology and pediatric surgery. Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find clinical context for the condition and procedure, typical sites of service, and the role of CPT code 42810 in surgical billing. The publication provides benchmarks and policy-oriented information relevant to coverage and reimbursement practices, highlights common documentation elements tied to surgical excision of congenital neck cysts, and notes where input data are not available. This national overview is intended to help coding, billing, and revenue teams understand the clinical rationale for the code and the payer landscape affecting claim adjudication.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareCPT 42810brachial cleft cystneck surgeryotolaryngologypediatric surgerysurgical excisionambulatory surgeryprocedure coding

Billing Code Overview

CPT code 42810 describes the surgical excision of a brachial cleft cyst (vestige), a congenital cystic swelling arising from the lateral aspect of the neck caused by failure of the second branchial (pharyngeal) cleft to close during embryonic development. This procedure involves removal of the cyst and tract as indicated to resolve infection, recurrence, or symptomatic mass effect.

Service type: Surgical excision of congenital neck cyst
Typical site of service: Ambulatory surgical center or hospital operating room, depending on case complexity and patient factors

Clinical & Coding Specifications

Clinical Context

A typical patient is a pediatric or young adult presenting with a painless, fluctuant lateral neck mass located along the anterior border of the sternocleidomastoid muscle, often present since birth and recently enlarged or recurrently infected. Evaluation includes history, physical exam, and imaging such as ultrasound or CT to define cyst extent and relationship to neurovascular structures. Preoperative counseling discusses risks, anesthesia plan, and possibility of intraoperative drainage or more extensive dissection if infected or adherent. The surgical workflow for 42810 (excision of brachial cleft cyst) typically involves general anesthesia, antiseptic preparation of the neck, a transverse skin incision placed cosmetically in a natural skin crease, careful dissection to identify and preserve the greater auricular nerve and branches of the facial nerve if the lesion extends cephalad, complete excision of the cyst and any tract or sinus, hemostasis, layered closure, and sterile dressing. Postoperative care includes short recovery, wound care instructions, analgesia, and follow-up for pathology review and suture removal. Patients with infected cysts may require preoperative antibiotics and possible incision and drainage prior to definitive excision; rare complications include hematoma, seroma, infection, nerve injury, and recurrence if excision is incomplete.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services

Related Codes

CPT-42815-BRACHIAL-CLEFT-CYST-EXCISION

CPT 42815: Brachial Cleft Cyst Excision

CPT-42826-TONSILLECTOMY-AGE-12-AND-OLDER

CPT 42826: Tonsillectomy for Patients Age 12 and Older

CPT-42894-PHARYNGEAL-WALL-PYRIFORM-SINUS-RECONSTRUCTION-FLAP

CPT 42894: Pharyngeal Wall or Pyriform Sinus Resection with Flap Closure

CPT-42844-TONSIL-AND-OROPHARYNGEAL-RESECTION-WITH-LOCAL-FLAP-CLOSURE

CPT 42844: Tonsil and Oropharyngeal Resection with Local Flap Closure

CPT-42892-LATERAL-PHARYNGEAL-WALL-PIRIFORM-SINUS-RESECTION-CLOSURE

CPT 42892: Lateral Pharyngeal Wall or Piriform Sinus Resection with Closure

CPT-42806-NASOPHARYNGEAL-BIOPSY-UNKNOWN-PRIMARY-LESION

CPT 42806: Biopsy of Unknown Primary Lesion of the Nasopharynx

CPT-42890-PHARYNGEAL-WALL-RESECTION-PARTIAL-THYROID-ALA-HYOID

CPT 42890: Partial Pharyngeal Wall Resection

CPT-42845-TONSIL-AND-OROPHARYNGEAL-RESECTION-WITH-CHEST-FLAP-RECONSTRUCTION

CPT 42845: Tonsil and Oropharyngeal Resection with Chest Flap Reconstruction

CPT-42825-PEDIATRIC-TONSILLECTOMY-UNDER-12

CPT 42825: Tonsillectomy in Patients Under 12 Years Old

CPT-42800-OROPHARYNGEAL-BIOPSY

CPT 42800: Oropharyngeal Biopsy, Diagnostic

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Taxonomy Code	Specialty	Notes
207Q00000X	Otolaryngology (ENT)	Common specialty performing neck congenital mass excisions.
207L00000X	Pediatric Otolaryngology	Subspecialty for pediatric presentations and complex congenital lesions.
2080P0001X	Plastic Surgery	Performs excision with attention to cosmesis and complex reconstructions.
208D00000X	General Surgery	May perform excision in older adolescents or adults with head and neck expertise.
207RI0200X	Head & Neck Surgery	Surgeons focusing on comprehensive head and neck procedures including congenital lesions.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`Q18.0`	Branchial cleft and pouch anomalies	Primary congenital diagnosis for which `42810` is performed.
`L02.91`	Cutaneous abscess, unspecified site	Relevant when the brachial cleft cyst becomes secondarily infected and requires drainage or excision.
`J39.2`	Cyst of pharynx, not elsewhere classified	Included when cystic lesions extend toward pharyngeal structures and differential includes pharyngeal cyst.
`R22.1`	Localized swelling, mass and lump, neck	Symptom code often used for initial presentation prior to definitive diagnosis.
`K12.2`	Cellulitis and abscess of oral soft tissues, excluding tonsils	Used when adjacent soft tissue infection is present in peripharyngeal regions associated with the cyst.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`10060`	Incision and drainage of abscess; simple or single	Performed prior to or as a temporizing measure for an infected brachial cleft cyst requiring drainage before definitive excision.
`10120`	Incision and removal of foreign body, subcutaneous tissues; simple	May be used if small superficial sinus tracts require limited excision separate from definitive cyst removal.
`12031`	Repair, intermediate, wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm to 7.5 cm	Used when layered closure with intermediate repair is reported for skin incisions after cyst excision.
`38220`	Lymph node excision, open, deep cervical node(s)	May be reported when lymph node sampling or excision is performed concurrently due to diagnostic uncertainty.
`64450`	Injection, anesthetic agent; trigeminal nerve block, single branch	Example of regional block code used when peripheral nerve block is performed adjunctively for postoperative analgesia (used per payer rules).