CPT code 42100: Palate biopsy, tissue sampling2026 Medicare rate & RVUs in Bartlett, Illinois
CPT 42100: $157.61–$158.56 office ($107.87–$109.89 facility) across 2 localities in Bartlett, IL in 2026 Medicare. Compare each area.
Medicare pays $157.61–$158.56 for 42100 in the office in Bartlett, Illinois, from Suburban Chicago, IL to Chicago, IL. Which amount applies depends on the service address.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
On this page 6 sections
Where 42100 pays more and less in Bartlett, Illinois
Bartlett, Illinois maps to 2 Medicare payment localities in our Census-to-CMS crosswalk. A city name alone doesn’t confirm an address’s payment area.
| Payment locality | Office | Facility |
|---|---|---|
| Chicago, IL | $158.56 | $109.89 |
| Suburban Chicago, IL | $157.61 | $107.87 |
How payment areas work in Bartlett
City limits and Medicare payment areas are different maps. These are the payment areas that cover the city’s counties; the service ZIP decides which one applies.
- Chicago · Cook County
- Suburban Chicago · DuPage County, Kane County
City boundaries: 2026 Census geography · Census source · CMS county-to-locality definitions
How the 42100 rate is calculated
Each of 42100’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.
How the rate is built · 42100
RVUs × geographic indexes × conversion factor
Work1.33
1.33 RVUs× 1.000 GPCI
Practice expense2.98
2.98 RVUs× 1.000 GPCI
Malpractice0.18
0.18 RVUs× 1.000 GPCI
Adjusted RVUs
4.4900
Conversion factor
$33.4009
Medicare rate
$149.97
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 42100
42100 has a 10-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 42100
Palate biopsy, tissue sampling
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 010 | Minor procedure: the day of the procedure plus 10 days after are included. |
| Multiple procedures | 2 | Standard reduction: highest-valued procedure at 100%, others at 50%. |
| Bilateral (modifier 50) | 0 | The 150% bilateral adjustment doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 1 | Not paid (statutory restriction). |
| Co-surgeons (62) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
| Split (54/55/56) | 0.10/0.80/0.10 | Share of the payment for pre-op, the procedure itself, and post-op care. |
Global surgery period · 42100
Palate biopsy, tissue sampling
10-day global period ends
Oct 11, 2026
Covers Oct 1, 2026 through Oct 11, 2026 (11 days).
Visit on Oct 31, 2026
After the global period ends: visits and procedures are billed normally.
What modifiers do to the payment
Modifier 51 · payment effect
With and without the modifier
42100 without 51 · national office
$149.97
Palate biopsy, tissue sampling
42100-51 · Second procedure: 50%
$74.99
When this isn’t the highest-valued procedure in the session, Medicare pays 50% of its fee schedule amount (the highest is paid at 100%).
Where these rates come from
FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.
CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027
Show the CMS file lines behind this rate
Fee sheets · Coming soon
Put 42100 and the rest of your codes on one sheet
Your codes at your locality, with payer contracts beside Medicare.
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