CPT 42260
Repair nose to lip fistula
CPT 42260 at a glance
- Code
- 42260
- Code type
- CPT/HCPCS
- Short descriptor
- Repair nose to lip fistula
- Category
- ASC Surgical
- ASC eligibility
- ASC-eligible (surgical)
- Typical setting
- Ambulatory surgery center (POS 24) or hospital outpatient department (POS 22).
- Medicare ASC rate
- $3,025.62 national · 2026Q2
What is CPT code 42260?
CPT 42260 is a CPT/HCPCS procedure code. Its official short descriptor is "Repair nose to lip fistula". In the ASC context it is grouped under ASC Surgical.
Is CPT 42260 eligible in an ambulatory surgery center (ASC)?
CPT 42260 can be performed in a certified ambulatory surgery center.
Where is CPT 42260 typically performed?
Ambulatory surgery center (POS 24) or hospital outpatient department (POS 22).
What is the Medicare ASC payment rate for CPT 42260?
The national Medicare ASC payment rate for CPT 42260 is $3,025.62 (CMS ASC Payment System, 2026Q2). This is the national, unadjusted amount published by CMS; the amount an individual ambulatory surgery center is paid is adjusted for local wage index and may differ. It reflects Medicare's facility payment only and does not include the surgeon's professional fee.
Which specialties use CPT 42260?
CPT 42260 is most associated with General Surgery.
Reference information about ASC eligibility and typical procedure setting. Codes, descriptors, and ASC-eligibility status change over time. This is a coding reference, not billing, coding, or legal advice. Always verify against current guidance and individual payer policy before scheduling or billing. CPT is a registered trademark of the American Medical Association.