CPT code 42104: Palatal excision, without closure2026 Medicare rate & RVUs

Medicare pays $218.44 for 42104 nationally in the office and $122.58 in a hospital or facility. Local office rates run $192.88–$290.04.

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

What 42104 covers

A surgeon removes a lesion from the roof of the mouth or uvula without closing the excision site. The service may be performed by an otolaryngologist or oral and maxillofacial surgeon in an office, ambulatory surgery center, or hospital. It represents removal of the lesion, rather than sampling tissue solely to establish a diagnosis or destroying the lesion in place.

Select this code when the operative report supports excision without closure; document the lesion’s location and the work performed. A 10-day global period includes related postoperative visits during that period. When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% multiple-procedure reduction. Modifier 50 is inappropriate for this code. 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.

Where 42104 pays more and less

The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.

109 of 109 payment localities

42104 rates by state

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

How the 42104 rate is calculated

Each of 42104’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.

Payment rules and modifiers for 42104

42104 has a 10-day global period: related visits in that window are included in the surgery payment.

What modifiers do to the payment

When to use modifier 51

42104 compared with similar codes

How to choose

42100Palate biopsyTissue sampling

42100 is for diagnostic biopsy. 42104 is for excision of the lesion without closure.

42106Palate excisionSimple primary closure

42106 includes simple repair after excision; 42104 is for excision without closure.

42107Palatal lesion excisionWith complex repair

42107 includes extensive repair after excision; 42104 describes excision without closure.

42160Palate lesion treatmentDestruction method

42160 treats a lesion by destruction. 42104 removes the lesion by excision.

Codes related to 42104

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

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

Open CMS sourceHow we calculate rates