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CPT code 42104: Palatal excision, without closure2026 Medicare rate & RVUs in Washington, DC area

Report this service when a clinician excises a lesion of the palate or uvula without closing the resulting site.

CMS RVU26DEffective Oct 1, 2026One payment locality1.1K Medicare services in 2024

In Washington, DC area, Medicare pays $250.01 for 42104 in the office and $137.09 when it’s performed in a hospital or facility.

$250.01Office (non-facility)
$137.09Hospital or facility
+14.5%vs the national office rate ($218.44)

Check a contract rate as a % of Medicare · 42104 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 42104 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in Washington, DC area
  2. What 42104 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 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.

How Washington, DC area compares for 42104

Across 109 of 109 payment localities, the office rate for 42104 runs from $192.88 in Arkansas to $290.04 in San Benito County, CA. Washington, DC area pays $250.01. The RVUs are the same everywhere; the geographic indexes change the dollars.

42104 in Washington, DC area vs other payment areas
  1. Washington, DC area · this page$250.01
  2. Los Angeles, CA · California$246.78−$3.23
  3. Miami, FL · Florida$236.07−$13.94
  4. Chicago, IL · Illinois$229.12−$20.89
  5. Manhattan, NY · New York$251.54+$1.53
  6. Alaska · Alaska$252.84+$2.83
  7. Alabama · Alabama$195.75−$54.26

Other areas in District of Columbia first, then benchmark localities. Bars start at $0.

Every other payment area

42104 in every other Medicare payment locality
Payment localityOfficeFacility
ArkansasArkansas$192.88$110.54
ArizonaArizona$212.55$119.66
Bakersfield, CACalifornia$231.59$126.53
Chico, CACalifornia$230.94$125.88
El Centro, CACalifornia$230.98$125.92
Fresno, CACalifornia$230.94$125.88
Hanford, CACalifornia$230.94$125.88
Madera, CACalifornia$230.94$125.88

42104 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.

$192.88

$260.49

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

View every state and territory as a table
42104 office rate range by state
State / territoryOffice rate rangeLocalities
AK$252.841
AL$195.751
AR$192.881
AZ$212.551
CA$230.94–$290.0429
CO$227.481
CT$233.101
DC$250.011
DE$216.101
FL$215.27–$236.073
GA$203.01–$222.582
GU$236.721
HI$236.721
IA$200.751
ID$202.091
IL$209.01–$229.124
IN$203.281
KS$199.821
KY$200.501
LA$200.20–$210.242
MA$226.10–$250.152
MD$220.26–$250.013
ME$203.19–$214.332
MI$205.82–$218.022
MN$217.791
MO$196.73–$210.973
MS$194.841
MT$218.431
NC$205.341
ND$214.081
NE$201.861
NH$223.921
NJ$235.71–$247.372
NM$206.971
NV$217.371
NY$208.46–$257.755
OH$204.931
OK$200.111
OR$215.64–$234.762
PA$205.25–$227.252
PR$220.051
RI$223.841
SC$205.491
SD$213.561
TN$200.851
TX$203.88–$226.768
UT$208.331
VA$213.63–$250.012
VI$220.051
VT$213.251
WA$225.67–$255.262
WI$206.811
WV$201.181
WY$216.531

See 42104 in every payment locality

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.

How the rate is built · 42104

RVUs × geographic indexes × conversion factor

Office or facility?

Work1.65

1.65 RVUs× 1.000 GPCI

Practice expense4.67

4.67 RVUs× 1.000 GPCI

Malpractice0.22

0.22 RVUs× 1.000 GPCI

Adjusted RVUs

6.5400

Conversion factor

$33.4009

Medicare rate

$218.44

Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.

The exact Washington, DC area inputs and CMS source lines

PPRRVU2026_Oct_nonQPP.csv

4,994

Code
42104
Physician work
1.65
Practice expense
4.67
Malpractice
0.22

GPCI2026.csv

39

Locality
Washington, DC area
Physician work
1.054
Practice expense
1.178
Malpractice
1.113
Office calculation for 42104 in Washington, DC area
ComponentRVULocality factorAdjusted
Physician work1.65× 1.0541.7391
Practice expense4.67× 1.1785.5013
Malpractice0.22× 1.1130.2449
Total RVUs7.4852
Conversion factor× 33.4009

Office rate, Washington, DC area$250.01

Office: (1.65 × 1.054 + 4.67 × 1.178 + 0.22 × 1.113) × $33.4009 = $250.01

Facility: (1.65 × 1.054 + 1.8 × 1.178 + 0.22 × 1.113) × $33.4009 = $137.09

Open 42104 in the RVU calculator

Payment rules and modifiers for 42104

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

CMS payment indicators · 42104

Palatal excision, without closure

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 · 42104

Palatal excision, without closure

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

42104 without 51 · national office

$218.44

Palatal excision, without closure

42104-51 · Second procedure: 50%

$109.22

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 42104

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

Codes related to 42104
CodeHow it relatesOffice range, Washington, DC area
Used instead
42100Palate biopsy, tissue samplingBiopsy samples palate or uvula tissue rather than excising the lesion.$170.77
42120Palate resection, extensive lesion or palateConsider for palate resection or a more extensive lesion resection.No office rate
42160Palate lesion treatment, destruction methodTreats a palate or uvula lesion by destruction rather than excision.$265.92
Same family
42106Palate excision, simple primary closurePalatal or uvular lesion excision with simple repair.$298.80
42107Palatal lesion excision, with complex repairPalatal or uvular lesion excision with extensive repair.$534.68

How 42104 has changed in Washington, DC area

42104 · Office / nonfacility

$250.01

Effective 2026-10-01

The base rate is $6.94 higher than on 2025-10-01, moving from $243.07 to $250.01 (2.9%).

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

    $243.07changed to$250.01

    • Conversion factor 32.3465 changed to 33.4009
    • Work RVU 1.69 changed to 1.65
    • Practice expense RVU 4.59 changed to 4.67
    • Work GPCI 1.057 changed to 1.054
    • Practice expense GPCI 1.192 changed to 1.178
    • Malpractice GPCI 1.168 changed to 1.113

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $252.51changed to$243.07

    • Conversion factor 33.2875 changed to 32.3465
    • Practice expense RVU 4.64 changed to 4.59
    • Malpractice RVU 0.23 changed to 0.22

    Held through RVU25B, RVU25C, RVU25D.

  3. March 9, 2024

    RVU24AR

    $248.39changed to$252.51

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $260.95changed to$248.39

    • Conversion factor 33.8872 changed to 32.7442
    • Practice expense RVU 4.65 changed to 4.64
    • Malpractice RVU 0.22 changed to 0.23
    • Work GPCI 1.056 changed to 1.057
    • Practice expense GPCI 1.214 changed to 1.192
    • Malpractice GPCI 1.231 changed to 1.168

  5. January 1, 2023

    RVU23A

    $267.40changed to$260.95

    • Conversion factor 34.6062 changed to 33.8872
    • Practice expense RVU 4.58 changed to 4.65
    • Work GPCI 1.054 changed to 1.056
    • Practice expense GPCI 1.236 changed to 1.214
    • Malpractice GPCI 1.294 changed to 1.231

    Held through RVU23B, RVU23C, RVU23D.

  6. January 1, 2022

    RVU22A

    $267.44changed to$267.40

    • Conversion factor 34.8931 changed to 34.6062
    • Practice expense RVU 4.54 changed to 4.58
    • Malpractice RVU 0.21 changed to 0.22

    Held through RVU22B, RVU22C, RVU22D.

  7. January 1, 2021

    RVU21A

    $263.16changed to$267.44

    • Conversion factor 36.0896 changed to 34.8931
    • Practice expense RVU 4.29 changed to 4.54
    • Malpractice RVU 0.22 changed to 0.21
    • Work GPCI 1.049 changed to 1.054
    • Practice expense GPCI 1.221 changed to 1.236
    • Malpractice GPCI 1.277 changed to 1.294

    Held through RVU21B, RVU21C, RVU21D.

  8. January 1, 2020

    RVU20A

    $260.03changed to$263.16

    • Conversion factor 36.0391 changed to 36.0896
    • Practice expense RVU 4.25 changed to 4.29
    • Malpractice RVU 0.26 changed to 0.22
    • Work GPCI 1.045 changed to 1.049
    • Practice expense GPCI 1.205 changed to 1.221
    • Malpractice GPCI 1.261 changed to 1.277

    Held through RVU20B, RVU20C, RVU20D.

  9. January 1, 2019

    RVU19A

    $258.01changed to$260.03

    • Conversion factor 35.9996 changed to 36.0391
    • Practice expense RVU 4.21 changed to 4.25

    Held through RVU19B, RVU19C, RVU19D.

  10. January 1, 2018

    RVU18AR1

    $260.52changed to$258.01

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 4.28 changed to 4.21
    • Work GPCI 1.048 changed to 1.045
    • Malpractice GPCI 1.271 changed to 1.261

    Held through RVU18B, RVU18C, RVU18D.

  11. January 1, 2017

    RVU17A

    $263.19changed to$260.52

    • Conversion factor 35.8043 changed to 35.8887
    • Practice expense RVU 4.35 changed to 4.28
    • Work GPCI 1.051 changed to 1.048
    • Malpractice GPCI 1.280 changed to 1.271

    Held through RVU17B, RVU17C, RVU17D.

  12. January 1, 2016

    RVU16A

    $262.87changed to$263.19

    • Conversion factor 35.9335 changed to 35.8043
    • Practice expense RVU 4.31 changed to 4.35
    • Malpractice RVU 0.27 changed to 0.26

    Held through RVU16B, RVU16C, RVU16D.

  13. July 1, 2015

    RVU15C

    $261.56changed to$262.87

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  14. January 1, 2015

    RVU15A

    $261.23changed to$261.56

    • Conversion factor 35.8228 changed to 35.7547
    • Practice expense RVU 4.37 changed to 4.31
    • Malpractice RVU 0.22 changed to 0.27
    • Work GPCI 1.050 changed to 1.051
    • Practice expense GPCI 1.202 changed to 1.205
    • Malpractice GPCI 1.205 changed to 1.280

    Held through RVU15B.

  15. January 1, 2014

    RVU14A

    $264.80changed to$261.23

    • Conversion factor 34.0230 changed to 35.8228
    • Practice expense RVU 4.80 changed to 4.37
    • Malpractice RVU 0.23 changed to 0.22
    • Work GPCI 1.049 changed to 1.050
    • Practice expense GPCI 1.198 changed to 1.202
    • Malpractice GPCI 1.130 changed to 1.205

    Held through RVU14B, RVU14C, RVU14D.

  16. January 1, 2013

    RVU13AR

    Earliest loaded release: $264.80

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$250.01$137.09RVU26D
2026-07-01$250.01$137.09RVU26C
2026-04-01$250.01$137.09RVU26B
2026-01-01$250.01$137.09RVU26A
2025-10-01$243.07$150.53RVU25D
2025-07-01$243.07$150.53RVU25C
2025-04-01$243.07$150.53RVU25B
2025-01-01$243.07$150.53RVU25A
2024-10-01$252.51$154.11RVU24D
2024-07-01$252.51$154.11RVU24C
2024-04-01$252.51$154.11RVU24B
2024-03-09$252.51$154.11RVU24AR
2024-01-01$248.39$151.60RVU24A
2023-10-01$260.95$157.28RVU23D
2023-07-01$260.95$157.28RVU23C
2023-04-01$260.95$157.28RVU23B
2023-01-01$260.95$157.28RVU23A
2022-10-01$267.40$159.61RVU22D
2022-07-01$267.40$159.61RVU22C
2022-04-01$267.40$159.61RVU22B
2022-01-01$267.40$159.61RVU22A
2021-10-01$267.44$159.19RVU21D
2021-07-01$267.44$159.19RVU21C
2021-04-01$267.44$159.19RVU21B
2021-01-01$267.44$159.19RVU21A
2020-10-01$263.16$161.81RVU20D
2020-07-01$263.16$161.81RVU20C
2020-04-01$263.16$161.81RVU20B
2020-01-01$263.16$161.81RVU20A
2019-10-01$260.03$163.62RVU19D
2019-07-01$260.03$163.62RVU19C
2019-04-01$260.03$163.62RVU19B
2019-01-01$260.03$163.62RVU19A
2018-10-01$258.01$164.74RVU18D
2018-07-01$258.01$164.74RVU18C
2018-04-01$258.01$164.74RVU18B
2018-01-01$258.01$164.74RVU18AR1
2017-10-01$260.52$166.24RVU17D
2017-07-01$260.52$166.24RVU17C
2017-04-01$260.52$166.24RVU17B
2017-01-01$260.52$166.24RVU17A
2016-10-01$263.19$167.84RVU16D
2016-07-01$263.19$167.84RVU16C
2016-04-01$263.19$167.84RVU16B
2016-01-01$263.19$167.84RVU16A
2015-10-01$262.87$168.04RVU15D
2015-07-01$262.87$168.04RVU15C
2015-04-01$261.56$167.20RVU15B
2015-01-01$261.56$167.20RVU15A
2014-10-01$261.23$165.64RVU14D
2014-07-01$261.23$165.64RVU14C
2014-04-01$261.23$165.64RVU14B
2014-01-01$261.23$165.64RVU14A
2013-10-01$264.80$165.35RVU13D
2013-07-01$264.80$165.35RVU13C
2013-04-01$264.80$165.35RVU13B
2013-01-01$264.80$165.35RVU13AR

Price 42104 for an earlier date of service

Where the Washington, DC area rate applies

Washington, DC area is a Medicare payment area, not a city. Our Census mapping connects it to 1 cities and communities in District of Columbia. Some span more than one payment area; confirm with the service ZIP.

  • Washington

Browse all communities in District of Columbia

42104 billing questions

How is this different from 42100?

42100 is for biopsy of the palate or uvula. Use 42104 when the clinician excises the lesion rather than taking tissue only for diagnostic sampling.

When should 42106 or 42107 be considered instead?

These are same-family codes for lesion excision with repair. Choose according to whether the operative documentation supports simple or extensive repair; 42104 describes excision without closure.

Are related postoperative visits separately reported?

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

Can modifier 50 be used for lesions on both sides?

No. The CMS bilateral adjustment does not apply, and modifier 50 is inappropriate for this code.

How are other procedures in the same session paid?

The highest-valued procedure is paid in full, and other procedures in the session are subject to the standard multiple-procedure reduction.

Can an assistant or co-surgeon be billed?

Medicare does not pay an assistant at surgery for this service. 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 42104PPRRVU2026_Oct_nonQPP.csv, line 4,994 (RVU26D)
Geographic factors for Washington, DC areaGPCI2026.csv, line 39 (RVU26D)

Open CMS sourceHow we calculate rates

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