2025 CPT code 42405
(Active) Effective Date: N/A Revision Date: N/A Deletion Date: N/A Surgery - Surgical Procedures on the Digestive System Surgery Feed
Incisional biopsy of a salivary gland.
Modifiers may apply depending on the circumstances of the procedure (e.g., 51 for multiple procedures, 22 for increased procedural services, location modifiers). Consult the CPT manual and payer guidelines for specific modifier application rules.
Medical necessity for an incisional salivary gland biopsy is established when there is a clinical indication of a salivary gland abnormality (e.g., palpable mass, recurrent swelling, persistent pain) requiring histopathological evaluation to guide treatment. This may include ruling out malignancy, confirming an autoimmune disorder like Sjogren's syndrome, or diagnosing other salivary gland pathology.
The physician or qualified healthcare professional performs the incision, obtains tissue samples, and closes the incision. They also prepare the sample for laboratory analysis.
In simple words: The doctor makes a small cut over the salivary gland to take tissue samples. These samples are sent to a lab for testing to find out what's causing any problems with the gland.
This procedure involves making a skin incision over the salivary gland to access the gland. Multiple pieces of glandular tissue (often 6-10) are obtained for diagnostic evaluation in a laboratory. The incision is closed with sutures, and the sample is placed in formalin solution for pathological evaluation.This is distinct from a needle biopsy (42400).
Example 1: A patient presents with a palpable mass in the parotid gland. An incisional biopsy is performed to determine if the mass is benign or malignant., A patient with symptoms suggestive of Sjögren's syndrome undergoes an incisional biopsy of a minor salivary gland (e.g., in the lip) to confirm the diagnosis., A patient with recurrent swelling and pain in the submandibular gland undergoes an incisional biopsy to rule out an obstruction or infection.
* Preoperative and postoperative diagnosis* Indication for the procedure* Number and location of tissue samples taken* Pathology report confirming the diagnosis.* Anesthesia documentation.* Operative report detailing the procedure.
** The source data does not contain additional notes relevant to this code.
- Revenue Code: P6C (MINOR PROCEDURES - OTHER)
- RVU: This information is not provided in the source data.RVUs vary by location and payer.
- Global Days: Global period information not specified. Consult payer-specific guidelines.
- Payment Status: Active
- Modifier TC rule: The source data does not explicitly address whether a Technical Component (TC) modifier applies. Consult payer-specific guidelines for this determination.
- Fee Schedule: Historical fee schedule data is not provided in the source.Refer to appropriate historical fee schedules for the relevant time period.
- Specialties:Oral and Maxillofacial Surgery, Otolaryngology
- Place of Service:Office, Ambulatory Surgical Center, Hospital (Inpatient or Outpatient)