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CPT code 42100: Palate biopsy, tissue sampling2026 Medicare rate & RVUs in Puerto Rico

Report this service when a clinician takes a tissue sample from the roof of the mouth for evaluation of a suspicious oral lesion.

CMS RVU26DEffective Oct 1, 2026One payment locality2.2K Medicare services in 2024

In Puerto Rico, Medicare pays $150.97 for 42100 in the office and $102.01 when it’s performed in a hospital or facility.

$150.97Office (non-facility)
$102.01Hospital or facility
+0.7%vs the national office rate ($149.97)

Check a contract rate as a % of Medicare · 42100 nationwide

Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.

We’ll open 42100 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in Puerto Rico
  2. What 42100 covers
  3. Compared with other areas
  4. Rate map
  5. How it’s calculated
  6. Payment rules
  7. Related codes
  8. Rate history
  9. Where it applies
  10. Billing questions
  11. Sources

What 42100 covers

This service covers taking a tissue sample from the palate, the roof of the mouth, for diagnostic examination. Otolaryngologists and oral and maxillofacial surgeons commonly perform it in an office, procedure room, or operating room when assessing a suspicious ulcer, patch, or mass. The work is sampling tissue for diagnosis, rather than removing a palate lesion as definitive treatment.

Select the code when the documented service is a palatal biopsy; record the sampled site, the finding or concern prompting the procedure, and the tissue submitted. CMS assigns a 10-day minor-procedure global period, so related postoperative visits during that interval are included. If multiple procedures subject to the standard reduction are performed in the same session, the highest-valued procedure is paid in full and the others at 50%. Palatal anatomy makes modifier 50 inappropriate. Medicare does not pay an assistant at surgery, and co-surgeon and team-surgery billing are not permitted.

This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.

How Puerto Rico compares for 42100

Across 109 of 109 payment localities, the office rate for 42100 runs from $133.02 in Arkansas to $196.06 in San Benito County, CA. Puerto Rico pays $150.97. The RVUs are the same everywhere; the geographic indexes change the dollars.

42100 in Puerto Rico vs other payment areas
  1. Puerto Rico · this page$150.97
  2. Los Angeles, CA · California$167.99+$17.02
  3. Washington, DC area · District of Columbia$170.77+$19.80
  4. Miami, FL · Florida$163.24+$12.27
  5. Chicago, IL · Illinois$158.56+$7.59
  6. Manhattan, NY · New York$172.46+$21.49
  7. Alaska · Alaska$175.95+$24.98

Other areas in Puerto Rico first, then benchmark localities. Bars start at $0.

Every other payment area

42100 in every other Medicare payment locality
Payment localityOfficeFacility
AlabamaAlabama$134.92$92.54
ArkansasArkansas$133.02$91.42
ArizonaArizona$146.02$99.09
Bakersfield, CACalifornia$158.02$104.94
Chico, CACalifornia$157.49$104.41
El Centro, CACalifornia$157.52$104.44
Fresno, CACalifornia$157.49$104.41
Hanford, CACalifornia$157.49$104.41

42100 rates by state

Office rate range in each state. Select a state to see its payment localities.

MEWIVTNHMTNDMNMINYMARIWAIDWYSDIAILINOHPANJCTORNVUTCONEMOKYWVVAMDDECAAZNMKSOKARTNNCSCDCTXLAMSALGAFLAKHI

Explore a state

Local rates. Clear comparisons.

Hover or focus a tile to see its rate range. Select it to open the state’s fee schedule.

$133.02

$176.78

Color shows the midpoint of each state’s locality range.

View every state and territory as a table
42100 office rate range by state
State / territoryOffice rate rangeLocalities
AK$175.951
AL$134.921
AR$133.021
AZ$146.021
CA$157.49–$196.0629
CO$155.561
CT$159.791
DC$170.771
DE$148.391
FL$148.61–$163.243
GA$140.37–$152.902
GU$161.081
HI$161.081
IA$137.881
ID$138.841
IL$144.70–$158.564
IN$139.611
KS$137.431
KY$138.411
LA$138.27–$144.922
MA$154.74–$170.442
MD$151.12–$170.773
ME$139.73–$146.862
MI$142.09–$150.612
MN$148.621
MO$136.08–$145.203
MS$134.571
MT$149.961
NC$141.131
ND$146.401
NE$138.571
NH$153.301
NJ$161.49–$169.102
NM$142.921
NV$149.071
NY$143.21–$176.785
OH$141.361
OK$137.981
OR$147.79–$160.192
PA$141.48–$156.012
PR$150.971
RI$153.451
SC$141.501
SD$145.981
TN$138.131
TX$140.59–$155.158
UT$143.381
VA$146.51–$170.772
VI$150.971
VT$146.001
WA$154.39–$173.692
WI$141.631
WV$139.521
WY$148.411

See 42100 in every payment locality

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

Office or facility?

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.

The exact Puerto Rico inputs and CMS source lines

PPRRVU2026_Oct_nonQPP.csv

4,993

Code
42100
Physician work
1.33
Practice expense
2.98
Malpractice
0.18

GPCI2026.csv

91

Locality
Puerto Rico
Physician work
1.000
Practice expense
1.011
Malpractice
0.985
Office calculation for 42100 in Puerto Rico
ComponentRVULocality factorAdjusted
Physician work1.33× 1.0001.3300
Practice expense2.98× 1.0113.0128
Malpractice0.18× 0.9850.1773
Total RVUs4.5201
Conversion factor× 33.4009

Office rate, Puerto Rico$150.97

Office: (1.33 × 1 + 2.98 × 1.011 + 0.18 × 0.985) × $33.4009 = $150.97

Facility: (1.33 × 1 + 1.53 × 1.011 + 0.18 × 0.985) × $33.4009 = $102.01

Open 42100 in the RVU calculator

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

RuleCMS valueWhat it means
Global period010Minor procedure: the day of the procedure plus 10 days after are included.
Multiple procedures2Standard reduction: highest-valued procedure at 100%, others at 50%.
Bilateral (modifier 50)0The 150% bilateral adjustment doesn’t apply.
Assistant at surgery (80/81/82/AS)1Not paid (statutory restriction).
Co-surgeons (62)0Not permitted.
Team surgery (66)0Not permitted.
Professional/technical0Physician service: no professional/technical split.
Split (54/55/56)0.10/0.80/0.10Share 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.

SurgeryVisit
Sep 28, 2026Oct 14, 2026

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%).

When to use modifier 51

Codes related to 42100

Related codes aren’t interchangeable: bill the code that matches the service performed.

Codes related to 42100
CodeHow it relatesOffice range, Puerto Rico
Same family
42104Palatal excision, without closurePalate lesion excision for a lesion 1 cm or less, rather than diagnostic tissue sampling.$220.05
42106Palate excision, simple primary closurePalate lesion excision for a lesion over 1 cm, rather than diagnostic tissue sampling.$263.40
42107Palatal lesion excision, with complex repairExtensive palate lesion excision, rather than diagnostic tissue sampling.$473.65

How 42100 has changed in Puerto Rico

42100 · Office / nonfacility

$150.97

Effective 2026-10-01

The base rate is $9.06 higher than on 2025-10-01, moving from $141.91 to $150.97 (6.4%).

It is unchanged from the immediately preceding available release, effective 2026-07-01.

Base rate by release · bars start at $0 · select a bar to compare

One bar per available release, ordered by effective date. Missing rates remain gaps. These comparisons hold the code, setting and locality identifiers constant; they do not isolate which policy or input caused a change.

What changed, release by release

  1. January 1, 2026

    RVU26A

    $141.91changed to$150.97

    • Conversion factor 32.3465 changed to 33.4009
    • Work RVU 1.36 changed to 1.33
    • Practice expense RVU 2.85 changed to 2.98
    • Malpractice RVU 0.16 changed to 0.18
    • Practice expense GPCI 1.007 changed to 1.011
    • Malpractice GPCI 0.982 changed to 0.985

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $147.36changed to$141.91

    • Conversion factor 33.2875 changed to 32.3465
    • Practice expense RVU 2.87 changed to 2.85
    • Malpractice RVU 0.18 changed to 0.16

    Held through RVU25B, RVU25C, RVU25D.

  3. March 9, 2024

    RVU24AR

    $144.95changed to$147.36

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $150.46changed to$144.95

    • Conversion factor 33.8872 changed to 32.7442
    • Practice expense RVU 2.88 changed to 2.87
    • Practice expense GPCI 1.008 changed to 1.007
    • Malpractice GPCI 0.984 changed to 0.982

  5. October 1, 2023

    RVU23D

    $149.78changed to$150.46

    • Practice expense GPCI 1.000 changed to 1.008
    • Malpractice GPCI 1.000 changed to 0.984

  6. January 1, 2023

    RVU23A

    $152.97changed to$149.78

    • Conversion factor 34.6062 changed to 33.8872
    • Practice expense RVU 2.86 changed to 2.88
    • Practice expense GPCI 1.008 changed to 1.000
    • Malpractice GPCI 0.986 changed to 1.000

    Held through RVU23B, RVU23C.

  7. January 1, 2022

    RVU22A

    $152.85changed to$152.97

    • Conversion factor 34.8931 changed to 34.6062
    • Practice expense RVU 2.84 changed to 2.86
    • Malpractice RVU 0.16 changed to 0.18

    Held through RVU22B, RVU22C, RVU22D.

  8. January 1, 2021

    RVU21A

    $153.01changed to$152.85

    • Conversion factor 36.0896 changed to 34.8931
    • Practice expense RVU 2.70 changed to 2.84
    • Malpractice GPCI 0.988 changed to 0.986

    Held through RVU21B, RVU21C, RVU21D.

  9. January 1, 2020

    RVU20A

    $154.86changed to$153.01

    • Conversion factor 36.0391 changed to 36.0896
    • Practice expense RVU 2.71 changed to 2.70
    • Malpractice RVU 0.21 changed to 0.16
    • Practice expense GPCI 1.007 changed to 1.008
    • Malpractice GPCI 0.990 changed to 0.988

    Held through RVU20B, RVU20C, RVU20D.

  10. January 1, 2019

    RVU19A

    $155.05changed to$154.86

    • Conversion factor 35.9996 changed to 36.0391
    • Practice expense RVU 2.72 changed to 2.71

    Held through RVU19B, RVU19C, RVU19D.

  11. January 1, 2018

    RVU18AR1

    $138.74changed to$155.05

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 2.77 changed to 2.72
    • Practice expense GPCI 0.856 changed to 1.007
    • Malpractice GPCI 0.642 changed to 0.990

    Held through RVU18B, RVU18C, RVU18D.

  12. January 1, 2017

    RVU17A

    $121.83changed to$138.74

    • Conversion factor 35.8043 changed to 35.8887
    • Practice expense RVU 2.81 changed to 2.77
    • Practice expense GPCI 0.705 changed to 0.856
    • Malpractice GPCI 0.293 changed to 0.642

    Held through RVU17B, RVU17C, RVU17D.

  13. January 1, 2016

    RVU16A

    $122.27changed to$121.83

    • Conversion factor 35.9335 changed to 35.8043

    Held through RVU16B, RVU16C, RVU16D.

  14. July 1, 2015

    RVU15C

    $121.66changed to$122.27

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  15. January 1, 2015

    RVU15A

    $120.28changed to$121.66

    • Conversion factor 35.8228 changed to 35.7547
    • Practice expense RVU 2.82 changed to 2.81
    • Malpractice RVU 0.17 changed to 0.21
    • Practice expense GPCI 0.692 changed to 0.705
    • Malpractice GPCI 0.271 changed to 0.293

    Held through RVU15B.

  16. January 1, 2014

    RVU14A

    $119.31changed to$120.28

    • Conversion factor 34.0230 changed to 35.8228
    • Practice expense RVU 3.10 changed to 2.82
    • Malpractice RVU 0.18 changed to 0.17
    • Practice expense GPCI 0.678 changed to 0.692
    • Malpractice GPCI 0.249 changed to 0.271

    Held through RVU14B, RVU14C, RVU14D.

  17. January 1, 2013

    RVU13AR

    Earliest loaded release: $119.31

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$150.97$102.01RVU26D
2026-07-01$150.97$102.01RVU26C
2026-04-01$150.97$102.01RVU26B
2026-01-01$150.97$102.01RVU26A
2025-10-01$141.91$108.68RVU25D
2025-07-01$141.91$108.68RVU25C
2025-04-01$141.91$108.68RVU25B
2025-01-01$141.91$108.68RVU25A
2024-10-01$147.36$111.16RVU24D
2024-07-01$147.36$111.16RVU24C
2024-04-01$147.36$111.16RVU24B
2024-03-09$147.36$111.16RVU24AR
2024-01-01$144.95$109.34RVU24A
2023-10-01$150.46$112.21RVU23D
2023-07-01$149.78$111.83RVU23C
2023-04-01$149.78$111.83RVU23B
2023-01-01$149.78$111.83RVU23A
2022-10-01$152.97$112.16RVU22D
2022-07-01$152.97$112.16RVU22C
2022-04-01$152.97$112.16RVU22B
2022-01-01$152.97$112.16RVU22A
2021-10-01$152.85$110.29RVU21D
2021-07-01$152.85$110.29RVU21C
2021-04-01$152.85$110.29RVU21B
2021-01-01$152.85$110.29RVU21A
2020-10-01$153.01$111.54RVU20D
2020-07-01$153.01$111.54RVU20C
2020-04-01$153.01$111.54RVU20B
2020-01-01$153.01$111.54RVU20A
2019-10-01$154.86$113.48RVU19D
2019-07-01$154.86$113.48RVU19C
2019-04-01$154.86$113.48RVU19B
2019-01-01$154.86$113.48RVU19A
2018-10-01$155.05$114.08RVU18D
2018-07-01$155.05$114.08RVU18C
2018-04-01$155.05$114.08RVU18B
2018-01-01$155.05$114.08RVU18AR1
2017-10-01$138.74$103.11RVU17D
2017-07-01$138.74$103.11RVU17C
2017-04-01$138.74$103.11RVU17B
2017-01-01$138.74$103.11RVU17A
2016-10-01$121.83$92.55RVU16D
2016-07-01$121.83$92.55RVU16C
2016-04-01$121.83$92.55RVU16B
2016-01-01$121.83$92.55RVU16A
2015-10-01$122.27$92.63RVU15D
2015-07-01$122.27$92.63RVU15C
2015-04-01$121.66$92.17RVU15B
2015-01-01$121.66$92.17RVU15A
2014-10-01$120.28$91.52RVU14D
2014-07-01$120.28$91.52RVU14C
2014-04-01$120.28$91.52RVU14B
2014-01-01$120.28$91.52RVU14A
2013-10-01$119.31$89.55RVU13D
2013-07-01$119.31$89.55RVU13C
2013-04-01$119.31$89.55RVU13B
2013-01-01$119.31$89.55RVU13AR

Price 42100 for an earlier date of service

Where the Puerto Rico rate applies

Puerto Rico is a Medicare payment area, not a city. Our Census mapping connects it to 292 cities and communities in Puerto Rico. Some span more than one payment area; confirm with the service ZIP.

  • Aceitunas
  • Adjuntas
  • Aguada
  • Aguadilla
  • Aguas Buenas
  • Aguas Claras
  • Aguilita
  • Aibonito

Browse all communities in Puerto Rico

42100 billing questions

When should this code be chosen instead of a palate excision code?

Use this code when the service is tissue sampling for diagnosis. When the procedure removes a palate lesion, consider the applicable excision code instead.

Can modifier 50 be reported for biopsies on both sides of the palate?

No. CMS identifies bilateral adjustment as inappropriate for this code because of the descriptor or anatomy.

Are related postoperative visits separately reported during the global period?

Related postoperative visits during the 10-day global period are included in the procedure.

What documentation supports reporting a palatal biopsy?

Document the palate site sampled, the clinical finding or concern that prompted sampling, and that tissue was obtained for diagnostic evaluation.

Can an assistant surgeon or co-surgeon be billed?

Medicare does not pay an assistant at surgery for this service, and co-surgeon and team-surgery billing are not permitted.

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
RVUs for 42100PPRRVU2026_Oct_nonQPP.csv, line 4,993 (RVU26D)
Geographic factors for Puerto RicoGPCI2026.csv, line 91 (RVU26D)

Open CMS sourceHow we calculate rates

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