🧬CPT Code 42410: Excision of Parotid Tumor or Parotid Gland; Lateral Lobe, Without Nerve Dissection

📋 Code Information

Field	Value
CPT Code	42410
Descriptor	Excision of parotid tumor or parotid gland; lateral lobe, without nerve dissection
Section	Salivary Gland and Duct Procedures (42300-42699)
Approach	Open surgical
Global Period	90 days
Effective Date	1990 (approx.)
Last Updated	2026-01-01 (no change from 2025)

📖 Clinical Description

42410 describes a surgical procedure to remove a tumor from the lateral (superficial) lobe of the parotid gland or to excise the lateral lobe itself, specifically without dissection of the facial nerve. The parotid gland is the largest of the three major paired salivary glands, located beneath and in front of the ear. It plays a crucial role in saliva production, which aids in digestion and oral health.^[1][2][4]

Anatomical Context^[2][7]

The parotid gland has two main lobes:

Lateral (Superficial) Lobe: The larger, more superficial portion that lies over the masseter muscle
Medial (Deep) Lobe: The portion that extends into the parapharyngeal space

The facial nerve (cranial nerve VII) courses through the parotid gland, dividing it into superficial and deep lobes. Preservation of this nerve is critical to maintain facial muscle function.

Procedure Steps^[2]

Incision: The surgeon makes an incision just anterior to the auricle of the ear, extending around the ear lobe and along the mandible.
Skin Flap Elevation: A skin flap is elevated to expose the parotid gland.
Gland Dissection: The inferior aspect of the parotid gland is carefully dissected off the sternocleidomastoid muscle, continuing until the digastric muscle is reached.
Facial Nerve Identification: The tissue anterior to the tip and superior to the tragus is meticulously dissected to expose the trunk of the facial nerve. Note for 42410: While the nerve is identified and preserved, this code specifies “without nerve dissection,” meaning the surgeon does not perform extensive dissection of the nerve branches beyond identification.^[7]
Lobe Excision: The lateral lobe of the parotid gland or the tumor within it is excised. If deeper dissection is necessary, a nerve stimulator may be utilized to identify and protect the facial nerve branches.
Hemostasis: Bleeding is controlled using electrocautery.
Drain Placement: A drain is typically placed through a separate incision behind the ear to facilitate postoperative drainage.
Closure: The platysma muscle, subcutaneous tissue, and skin are closed in layers.

Indications^[2][4]

Benign parotid tumors (e.g., pleomorphic adenoma, Warthin’s tumor)
Malignant parotid tumors (e.g., mucoepidermoid carcinoma, adenoid cystic carcinoma)^[4]
Chronic sialadenitis of the parotid gland
Parotid gland obstruction or dysfunction
Suspicious parotid mass requiring excision for diagnosis and treatment

🔍 Includes and Inclusions

Lateral Lobe Excision: Removal of the superficial portion of the parotid gland^[2][7]
Tumor Excision: Removal of a mass from the lateral lobe^[2]
Without Nerve Dissection: Code is specific to procedures where the facial nerve is not extensively dissected^[2][7]

🚫 Excludes and Differentiating Codes

Critical Distinction: Nerve Dissection^[2][7]

The presence or absence of facial nerve dissection is the key factor in code selection:

Code	Description	When to Use
42410	Lateral lobe, without nerve dissection	Minimal nerve identification only; no extensive branch dissection^[2][7]
42415	Lateral lobe, with dissection and preservation of facial nerve	Extensive nerve dissection required to remove tumor while preserving nerve^[2][7]
42420	Total parotidectomy, with dissection and preservation of facial nerve	Complete gland removal with nerve preservation
42425	Total parotidectomy, en bloc removal with sacrifice of facial nerve	Complete removal including nerve sacrifice (malignancy)

Other Salivary Gland Excision Codes

Code	Description	Differentiating Factor
42408	Excision of sublingual salivary cyst (ranula)	Sublingual gland, not parotid
42440	Excision of submandibular (submaxillary) gland	Submandibular gland, not parotid
42450	Excision of sublingual gland	Sublingual gland, not parotid

Procedures Not Reported with 42410

Situation	Rationale
Biopsy only	Use 42400 (needle) or 42405 (incisional)
Simple cyst removal (pre-auricular area)	Not parotid; use appropriate skin/soft tissue codes (21011, 11400-11646)^[1]
Intraoperative nerve monitoring (when performed by another provider)	Report separately with 95940 if performed by different individual^[7]

📊 Code Tree and Hierarchy

flowchart TD
    A["42300-42699 Salivary Gland and Duct Procedures"] --> B["Incision and Drainage"]
    B --> C["42300 Drainage of parotid abscess"]
    B --> D["42305 Drainage of parotid abscess; complicated"]
    
    A --> E["Biopsy Procedures"]
    E --> F["42400 Needle biopsy of salivary gland"]
    E --> G["42405 Incisional biopsy of salivary gland"]
    
    A --> H["Excision Procedures - Parotid"]
    H --> I["42410 EXCISION - LATERAL LOBE, WITHOUT NERVE DISSECTION"]
    H --> J["42415 EXCISION - LATERAL LOBE, WITH NERVE DISSECTION"]
    H --> K["42420 TOTAL PAROTIDECTOMY, WITH NERVE PRESERVATION"]
    H --> L["42425 TOTAL PAROTIDECTOMY, EN BLOC WITH NERVE SACRIFICE"]
    H --> M["42426 TOTAL PAROTIDECTOMY, WITH UNILATERAL NERVE GRAFT"]
    
    A --> N["Excision Procedures - Other Glands"]
    N --> O["42408 Ranula excision"]
    N --> P["42440 Submandibular gland excision"]
    N --> Q["42450 Sublingual gland excision"]
    
    style I fill:#4169E1,stroke:#333,stroke-width:2px,color:white

🔄 Modifiers and Billing Nuances

Applicable Modifiers for 42410^[2]

Modifier	Description	Application
22	Increased Procedural Services	Use when work required is substantially greater than typical (e.g., extensive adhesions, large tumor, difficult anatomy). Documentation must support the additional work.^[2]
50	Bilateral Procedure	Use if bilateral parotid procedures are performed during the same operative session. Note: 150% payment adjustment applies.^[2]
51	Multiple Procedures	Use when multiple procedures are performed during the same session; standard payment adjustment rules apply. Medicare applies automatically.^[2]
52	Reduced Services	Use when service is partially reduced or eliminated.^[2]
53	Discontinued Procedure	Use if procedure started but discontinued due to patient instability or unforeseen circumstances.^[2]
58	Staged or Related Procedure	Use for planned staged procedure during postoperative period.^[2]
59	Distinct Procedural Service	Use to indicate procedure is distinct from other services performed on same day.^[2]
62	Two Surgeons	Use when two surgeons work as co-surgeons performing distinct parts of procedure. Documentation required.^[2]
78	Unplanned Return to OR	Use for related procedure during postoperative period (e.g., evacuation of hematoma).^[2]
79	Unrelated Procedure	Use for unrelated procedure during postoperative period.^[2]
LT/RT	Left/Right side	Use to specify laterality when needed.

Assistant Surgeon Modifiers for 42410^[2]

Modifier	Description	Payment Status
80	Assistant Surgeon	Payment restriction does NOT apply - assistant may be paid^[2]
81	Minimum Assistant Surgeon	Minimal assistance during portion of surgery^[2]
82	Assistant Surgeon (resident not available)	Teaching hospital when resident unavailable^[2]
AS	Non-Physician Assistant at Surgery	PA, NP, RNFA, CNS assisting

Important Modifier Notes

Modifier 22 Documentation: When billing for increased complexity, the operative report must clearly document the unusual circumstances (e.g., “tumor adherent to facial nerve requiring meticulous dissection,” “significant scarring from prior surgery”)^[2]
Modifier 50 for Bilateral: If bilateral procedures are performed, append modifier 50 to a single line item, or use two line items with modifiers LT and RT depending on payer preference^[2]

👨‍⚕️ Assistant Surgeon (Modifier 80) Payability

Assistant Surgeon Status for 42410^[2]

For 42410, the Assistant Surgeon indicator is 2, meaning payment restriction for assistants at surgery does NOT apply. This indicates that assistant surgeon services may be payable when medically necessary.

Indicator	Meaning	Application to 42410
0	Payment restriction applies; supporting documentation required	—
1	Statutory payment restriction; assistants not paid	—
2	Payment restriction does NOT apply; assistants may be paid	✅ Applicable^[2]
9	Concept does not apply	—

Co-Surgeon Status^[2]

For 42410, the Co-Surgeon indicator is 1, meaning co-surgeons could be paid, though supporting documentation is required.^[2] This may apply in complex cases where two surgeons (e.g., ENT and neurotologist) work together.

Team Surgery Status^[2]

For 42410, the Team Surgery indicator is 0, meaning team surgeons are not permitted for this procedure.^[2]

Documentation Requirements for Teaching Hospitals

If an assistant surgeon is used, documentation must support one of the following when the surgery is performed in a teaching hospital:

A statement that no qualified resident was available to perform the service
A statement indicating that exceptional medical circumstances exist
A statement indicating the primary surgeon has an across-the-board policy of never involving residents in patient care

Clinical Justification for Assistant

Given the complexity of parotid surgery and the proximity to the facial nerve, assistant surgeon services are frequently medically necessary. Documentation should clearly explain why an assistant was required (e.g., “due to the tumor’s proximity to the facial nerve and need for meticulous hemostasis, an assistant surgeon was necessary to ensure safe completion of the procedure”).

💰 Work RVU (wRVU) and Reimbursement

Work RVU Information

The Work Relative Value Units (wRVU) for 42410 are updated annually by CMS. For current values:

2026 Reference: Consult the most recent CMS Physician Fee Schedule (PFS) Final Rule or the AMA RBRVS DataManager
Reimbursement Factors: Final payment determined by:
- Total RVUs (Work + Practice Expense + Malpractice)
- Geographic Practice Cost Index (GPCI) for your area
- National conversion factor

2026 Medicare Payment Updates

Factor	Value
Conversion Factor (non-QP)	$33.4009
Conversion Factor (QP)	$33.5675
Efficiency Adjustment	-2.5% applied to work RVUs for non-time-based codes, including 42410

Important Note: CMS has finalized a -2.5% productivity/efficiency adjustment applied to work RVUs for approximately 7,700 non-time-based codes, including surgical procedures. This will affect the 2026 wRVU values compared to prior years.

Medicare Coverage^[1]

42410 is reimbursed by Medicare
Code is listed on the Medicare Physician Fee Schedule (MPFS), indicating it is a covered service
Coverage and reimbursement may vary depending on the specific Medicare Administrative Contractor (MAC) in your region

Facility vs. Non-Facility Payment

Facility setting (hospital inpatient/outpatient): Lower practice expense RVUs
Non-facility setting (office/ASC): Higher practice expense RVUs

📋 Documentation Requirements

To support billing of 42410, the operative report should clearly document:^[2][4][7]

Preoperative Diagnosis: Specific indication for surgery (e.g., “pleomorphic adenoma of left parotid,” “parotid mass”)
Procedure Performed: “Excision of lateral lobe of parotid gland” or “superficial parotidectomy”
Laterality: Right, left, or bilateral
Tumor Description: Size, location within gland, and characteristics
Facial Nerve Status: Explicit statement that nerve dissection was NOT performed (or that only minimal identification occurred, not extensive branch dissection)^[7]
Findings: Description of intraoperative findings and any unexpected issues
Nerve Monitoring: Whether a nerve stimulator was used (if applicable)
Drain Placement: Whether a drain was placed
Complications: Any intraoperative issues
Specimen Handling: Description of specimens sent to pathology^[4]

Critical Documentation Elements^[4][7]

Element	Why It Matters
Nerve Dissection Status	Critical for distinguishing 42410 from 42415^[7]
Laterality	Supports correct coding
Tumor Location (Lateral vs. Deep)	Confirms appropriateness of lateral lobe code
Pathology Results	Supports diagnosis coding (wait for final path if possible)^[4]

Timing of Diagnosis Coding^[4]

Initial coding: May use “parotid mass” or suspected diagnosis
Final coding: Wait for pathology report to assign definitive diagnosis (e.g., “mucoepidermoid carcinoma” → C07)^[4]
Tip: Never assign “uncertain behavior” for a confirmed malignancy^[4]

📊 ICD-10 Crosswalk and HCC Information

Primary ICD-10 Diagnoses for 42410^{[3][4][5][8][9][10]}

ICD-10 Code	Description	HCC Applicability
C07	Malignant neoplasm of parotid gland	Yes (HCC 8 or 10)^{[3][4][5][8][9]}
D11.0	Benign neoplasm of parotid gland	No (0)
D11.7	Benign neoplasm of other major salivary glands	No (0)
D11.9	Benign neoplasm of major salivary gland, unspecified	No (0)
K11.8	Other diseases of salivary glands	No (0)
K11.9	Disease of salivary gland, unspecified	No (0)
K11.20	Sialoadenitis, unspecified	No (0)
K11.21	Acute sialoadenitis	No (0)
K11.22	Chronic sialoadenitis	No (0)
K11.23	Parotitis	No (0)
K11.3	Abscess of salivary gland	No (0)
K11.4	Fistula of salivary gland	No (0)
K11.5	Sialolithiasis	No (0)
K11.6	Mucocele of salivary gland	No (0)
R22.1	Localized swelling, mass and lump, neck	No (0)
Z85.819	Personal history of malignant neoplasm of oral cavity	No (0)

Other Salivary Gland Malignancy Codes^[6][8]

ICD-10 Code	Description	HCC Applicability
C08.0	Malignant neoplasm of submandibular gland	Yes (HCC 8 or 10)^[6]
C08.1	Malignant neoplasm of sublingual gland	Yes (HCC 8 or 10)^[6]
C08.9	Malignant neoplasm of major salivary gland, unspecified	Yes (HCC 8 or 10)^[6]

HCC Note^{[3][4][5][8][9]}

Malignant neoplasms of the salivary glands (C07, C08.0, C08.1) are significant risk adjusters in HCC models, typically mapping to HCC 8 or 10 depending on the specific CMS-HCC model version^[3][8][9]
Benign neoplasms and non-neoplastic conditions (D11.0, K11.8, etc.) do not contribute to HCC risk scores
The excision procedure code itself (42410) is a CPT code and does not contribute to HCC risk adjustment

ICD-9 Crosswalk

ICD-9-CM Code	Description	Mapping Type
142.0	Malignant neoplasm of parotid gland	Approximate/GEM
210.2	Benign neoplasm of major salivary glands	Approximate/GEM
527.8	Other specified diseases of the salivary glands	Approximate/GEM

🏥 MS-DRG Assignment

When performed in an inpatient setting, parotidectomy procedures map to the following Medicare Severity-Diagnosis Related Groups (MS-DRGs):^[3]

For Salivary Gland Procedures

MS-DRG	Description
139	Salivary gland procedures

For Malignant Diagnoses (e.g., C07)^[3]

MS-DRG	Description
146	Ear, nose, mouth and throat malignancy with MCC
147	Ear, nose, mouth and throat malignancy with CC
148	Ear, nose, mouth and throat malignancy without CC/MCC

For Other Mouth Procedures^[3]

MS-DRG	Description
137	Mouth procedures with CC/MCC
138	Mouth procedures without CC/MCC

ICD-10-PCS Procedure Codes

For hospital inpatient coding, parotidectomy procedures are reported with ICD-10-PCS codes:

Approach	ICD-10-PCS Code	Description
Open	0GTC0ZZ	Resection of Right Parotid Gland, Open Approach
Open	0GTD0ZZ	Resection of Left Parotid Gland, Open Approach
Open	0GB30ZZ	Excision of Right Parotid Gland, Open Approach
Open	0GB40ZZ	Excision of Left Parotid Gland, Open Approach

📝 Coding Examples and Scenarios

Example 1: Superficial Parotidectomy for Benign Tumor

Scenario: A 45-year-old patient presents with a 2 cm mass in the left parotid gland. Fine needle aspiration suggests pleomorphic adenoma. The surgeon performs a superficial parotidectomy, removing the lateral lobe without extensive facial nerve dissection. The facial nerve is identified and preserved but not dissected into branches. Coding:

42410 - LT (Excision of parotid tumor or parotid gland; lateral lobe, without nerve dissection, left side)
D11.0 (Benign neoplasm of parotid gland) - after pathology confirms
Rationale: Classic superficial parotidectomy with nerve preservation but without extensive dissection.^[2][7]

Example 2: Superficial Parotidectomy with Increased Complexity

Scenario: A 60-year-old patient with a recurrent pleomorphic adenoma undergoes superficial parotidectomy. There is extensive scarring from prior surgery, making dissection difficult. The procedure takes significantly longer than usual. Coding:

42410 - 22 - LT (Excision of parotid tumor or parotid gland; lateral lobe, without nerve dissection, increased procedural services, left side)
D11.0 (Benign neoplasm of parotid gland)
Rationale: Modifier 22 is appropriate when the work required is substantially greater than typical. Documentation must support the increased complexity (scarring, adhesions, prolonged operative time).^[2]

Example 3: Superficial Parotidectomy with Assistant Surgeon

Scenario: A 70-year-old patient with a large benign tumor undergoes superficial parotidectomy. Due to the tumor size and proximity to the facial nerve, an assistant surgeon is necessary to ensure safe completion. Coding:

Primary Surgeon: 42410 - LT (Excision of parotid tumor or parotid gland; lateral lobe, without nerve dissection, left side)
Assistant Surgeon: 42410 - 80 - LT (Excision of parotid tumor or parotid gland; lateral lobe, without nerve dissection, with assistant surgeon, left side)
Diagnosis: D11.0 (Benign neoplasm of parotid gland)
Rationale: 42410 has assistant surgeon indicator 2, meaning payment restrictions do NOT apply. Documentation should support the medical necessity for an assistant.^[2]

Example 4: Mucoepidermoid Carcinoma - Wait for Pathology

Scenario: A 55-year-old patient undergoes superficial parotidectomy for a parotid mass. The surgeon suspects benign tumor but pathology returns as “mucoepidermoid carcinoma.” Coding:

Procedure: 42410 - RT (Excision of parotid tumor or parotid gland; lateral lobe, without nerve dissection, right side)
Diagnosis: C07 (Malignant neoplasm of parotid gland) - based on final pathology
Rationale: Always wait for the pathology report to assign the most specific diagnosis. “Mucoepidermoid carcinoma” of the parotid maps to C07.^[4]

Example 5: Bilateral Superficial Parotidectomy

Scenario: A patient with bilateral benign parotid tumors undergoes excision of both lateral lobes during the same operative session. Coding:

42410 - 50 (Excision of parotid tumor or parotid gland; lateral lobe, without nerve dissection, bilateral)
D11.0 (Benign neoplasm of parotid gland)
Rationale: Modifier 50 indicates bilateral procedure. 150% payment adjustment applies.^[2]

Example 6: Superficial Parotidectomy with Intraoperative Nerve Monitoring

Scenario: The surgeon performs superficial parotidectomy. A neurologist provides continuous intraoperative nerve monitoring during the procedure. Coding:

Surgeon: 42410 - RT (Excision of parotid tumor or parotid gland; lateral lobe, without nerve dissection)
Neurologist: 95940 (Continuous intraoperative neurophysiology monitoring, each 15 minutes) for the monitoring time
Rationale: When performed by a different provider, intraoperative nerve monitoring may be reported separately with 95940.^[7]

Example 7: Superficial Parotidectomy with Skin Substitute Graft

Scenario: The surgeon performs superficial parotidectomy and closes the defect with a skin substitute graft (acellular dermal matrix). Coding:

42410 - RT (Excision of parotid tumor or parotid gland; lateral lobe, without nerve dissection)
15275-15278 (Application of skin substitute graft to face, scalp, eyelids, mouth, neck, ears, orbits…) depending on area size
Rationale: For grafts on the face/neck area, use 15275-15278, not 15777 (which is for breast/trunk).^[7]

Example 8: Incorrect Coding - Superficial Parotidectomy with Nerve Dissection

Scenario: The surgeon performs superficial parotidectomy with extensive dissection of the facial nerve branches to remove a tumor intimately involved with the nerve. Coding:

Correct: 42415 (Excision of parotid tumor or parotid gland; lateral lobe, with dissection and preservation of facial nerve)
Incorrect: 42410
Rationale: When extensive nerve dissection is performed, 42415 is the appropriate code, not 42410.^[7]

⚠️ Important Coding Notes

Code Selection Algorithm for Parotidectomy^[7]

When selecting the appropriate parotidectomy code, consider:

Extent of Gland Removed:
- Lateral lobe only → 42410 or 42415
- Total parotidectomy → 42420, 42425, or 42426
Nerve Management:
- Without nerve dissection (minimal identification only) → 42410^[7]
- With dissection and preservation → 42415 (lateral) or 42420 (total)^[7]
- With sacrifice of nerve → 42425 (total, en bloc)
- With nerve graft → 42426 (total, with graft)

Global Period^[2]

42410 has a 90-day global period
All routine post-operative care is included in the global period
Complications requiring return to OR may be billed with modifier 78
Unrelated procedures during the global period may be billed with modifier 79

Intraoperative Nerve Monitoring^[7]

When performed by the surgeon: Included in the procedure (not separately billable)
When performed by another provider (e.g., neurologist, neurophysiologist): May be reported separately with 95940 for each 15 minutes of one-on-one monitoring^[7]
The monitoring provider must bill under their own NPI

Skin Grafts and Flaps^[7]

For skin substitute grafts on face/neck: Use 15275-15278, not 15777^[7]
For autologous skin grafts: Use appropriate graft codes
For local flaps: Use appropriate flap codes (e.g., 14040-14350)

Frozen Section

Intraoperative frozen section pathology is included in the surgical package for the pathologist, not the surgeon. Surgeons should not bill separately for obtaining frozen sections.

Lymph Node Dissection

If neck dissection is performed concurrently with parotidectomy (e.g., for malignancy), appropriate neck dissection codes (38500-38542, 38700-38724) may be reported separately with modifier 51.

Parotidectomy Codes

Code	Description
42410	Excision of parotid tumor or parotid gland; lateral lobe, without nerve dissection
42415	Excision of parotid tumor or parotid gland; lateral lobe, with dissection and preservation of facial nerve
42420	Excision of parotid tumor or parotid gland; total, with dissection and preservation of facial nerve
42425	Excision of parotid tumor or parotid gland; total, en bloc removal with sacrifice of facial nerve
42426	Excision of parotid tumor or parotid gland; total, en bloc removal with sacrifice of facial nerve and graft

Biopsy Codes

Code	Description
42400	Biopsy of salivary gland; needle
42405	Biopsy of salivary gland; incisional

Neck Dissection Codes (for concurrent malignancy)

Code	Description
38700	Suprahyoid lymphadenectomy
38720	Cervical lymphadenectomy (complete)
38724	Cervical lymphadenectomy (modified radical)

Intraoperative Nerve Monitoring

Code	Description
95940	Continuous intraoperative neurophysiology monitoring in the operating room, one on one monitoring requiring personal attendance, each 15 minutes^[7]

Skin Graft Codes (for closure)

Code	Description
15275-15278	Application of skin substitute graft to face, scalp, eyelids, mouth, neck, ears, orbits^[7]
15115-15116	Epidermal autograft

Unlisted Codes

Code	Description
42699	Unlisted procedure, salivary glands and ducts
17999	Unlisted procedure, skin, mucous membrane and subcutaneous tissue^[7]

References

¹ AAPC. “Reader Question: Hemostasis and Reporting Excision Code.” (2014) ² Coding Ahead. “CPT® Code 42410.” (2026) ³ Find-A-Code. “ICD-10-CM Diagnosis Codes - C07.” (2026) ⁴ AAPC. “Follow Documentation, Definition, Deduction for Diagnosis Code.” (2018) ⁵ emedcodes.com. “ICD 10 Diagnosis Codes related to Malignant neoplasm of parotid gland.” (2026) ⁶ Medcode.ch. “ICD-10-CM 2018: C08 Malignant neoplasm of other and unspecified major salivary glands.” (2018) ⁷ AAPC. “Base Parotidectomy Code Selection on Lobes Removed and Facial Nerve Dissection.” (2016) ⁸ Cancer Therapy Advisor. “Oncology ICD-10 Codes.” (2024) ⁹ The Cardiovascular. “C07 - Malignant neoplasm of parotid gland.” (2024) ¹⁰ vrb.gov.au. “Malignant Neoplasm of the Salivary Gland B040.” (2023)

Explorer

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