CPT 42810
Global 090 ActiveExcision of neck cyst
CPT 42810 Billing & Documentation Guide
CPT code 42810 (Excision of neck cyst) is classified under Surgery (Digestive) with a global period indicator of 090. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 3.3, a non-facility practice expense RVU of 7.79, and a malpractice RVU of 0.47, a total non-facility RVU of 11.56 and facility RVU of 7.72. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $397.46, though rates vary from $341.81 to $505.96 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 42810, ensure documentation supports medical necessity and the specific components required for the code's level of service. For E/M codes, document MDM (medical decision-making) elements: problems addressed, data reviewed, and risk. For procedural codes, document the indication, technique, and any complications. Always verify NCCI edits before bundling 42810 with related codes; this code has 10 PTP bundling relationships on file (see table below).
Payment Status & Global Period
Active code (paid under MPFS)
90-day global period (major surgery: 1 day pre-op + procedure + 90 days post-op)
MUE Limit (Medically Unlikely Edits)
Submitting more than 1 units of 42810 for the same patient on the same date triggers automatic line denial unless an appropriate modifier and supporting documentation justify the higher quantity.
RVU Breakdown, CPT 42810
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 3.3 | 3.3 |
| Practice Expense RVU | 7.79 | 3.95 |
| Malpractice RVU | 0.47 | 0.47 |
| Total RVU | 11.56 | 7.72 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 42810
State-level averages across all MAC localities. Non-facility rates typically apply to office-based services; facility rates apply to hospital outpatient / inpatient.
| State | Non-Facility | Facility | Range (Non-Fac) | Localities |
|---|---|---|---|---|
| California | $430.57 | $278.8 | $405.68 - $505.96 | 29 |
| Florida | $401.84 | $273.16 | $382.56 - $420.79 | 3 |
| Georgia | $377.4 | $255.04 | $361.03 - $393.76 | 2 |
| Illinois | $392.02 | $268.09 | $372.32 - $408.52 | 4 |
| Michigan | $376.64 | $256.21 | $365.5 - $387.78 | 2 |
| North Carolina | $363.01 | $243.35 | $363.01 - $363.01 | 1 |
| New York | $427.06 | $283.98 | $368.44 - $455.8 | 5 |
| Ohio | $363.6 | $246.5 | $363.6 - $363.6 | 1 |
| Pennsylvania | $382.86 | $257.22 | $363.92 - $401.8 | 2 |
| Texas | $381.57 | $255.3 | $361.58 - $399.64 | 8 |
Source: CMS PFSRVU 2026 · Updated 2026-04-01. Full locality-level detail available for all 53 states, contact us for custom reports.
NCCI Bundling Edits, CPT 42810
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 42810 on the same date of service, review the modifier indicator and payer policy before submission.
| Partner Code | Relationship | Modifier Allowed | Rationale |
|---|---|---|---|
| 00170 | Column 1 (primary), can be billed with modifier | No | Anesthesia service included in surgical procedure |
| 0213T | Column 1 (primary), can be billed with modifier | No | Misuse of Column Two code with Column One code |
| 0216T | Column 1 (primary), can be billed with modifier | No | Misuse of Column Two code with Column One code |
| 0228T | Column 1 (primary), can be billed with modifier | No | Standards of medical/surgical practice |
| 0230T | Column 1 (primary), can be billed with modifier | No | Standards of medical/surgical practice |
| 0596T | Column 1 (primary), can be billed with modifier | Yes | Standards of medical/surgical practice |
| 0597T | Column 1 (primary), can be billed with modifier | Yes | Standards of medical/surgical practice |
| 0708T | Column 1 (primary), can be billed with modifier | Yes | Standards of medical/surgical practice |
| 0709T | Column 1 (primary), can be billed with modifier | Yes | Standards of medical/surgical practice |
| 0903T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
Frequently Asked Questions, CPT 42810
What does CPT code 42810 mean? +
CPT code 42810 represents: Excision of neck cyst. It's in the Surgery (Digestive) category with a global period of 090.
What is the Medicare reimbursement for CPT 42810? +
The 2026 Medicare national average non-facility payment for CPT 42810 is $397.46. Rates range from $341.81 to $505.96 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 42810? +
Surgery codes commonly use modifier 22 (increased procedural services), 50 (bilateral), 51 (multiple procedures), 52 (reduced services), 58/78/79 (staged, unplanned return, unrelated within global), 62 (co-surgeons), 80/82 (assistant surgeon), and 59 or the X{EPSU} subset for distinct procedural service.
What bundling edits apply to CPT 42810? +
This code has 10 NCCI PTP bundling relationships. See the NCCI Bundling section below for full list.
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Reviewed by the PayerReady Medical Coding Team
Verified against the CMS 2026 code set on June 1, 2026.
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