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

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 Iowa, Medicare pays $200.75 for 42104 in the office and $113.04 when it’s performed in a hospital or facility.

$200.75Office (non-facility)
$113.04Hospital or facility
−8.1%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 Iowa
  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 Iowa 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. Iowa pays $200.75. The RVUs are the same everywhere; the geographic indexes change the dollars.

42104 in Iowa vs other payment areas
  1. Iowa · this page$200.75
  2. Los Angeles, CA · California$246.78+$46.03
  3. Washington, DC area · District of Columbia$250.01+$49.26
  4. Miami, FL · Florida$236.07+$35.32
  5. Chicago, IL · Illinois$229.12+$28.37
  6. Manhattan, NY · New York$251.54+$50.79
  7. Alaska · Alaska$252.84+$52.09

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

Every other payment area

42104 in every other Medicare payment locality
Payment localityOfficeFacility
AlabamaAlabama$195.75$111.88
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

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 Iowa 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

53

Locality
Iowa
Physician work
1.000
Practice expense
0.915
Malpractice
0.397
Office calculation for 42104 in Iowa
ComponentRVULocality factorAdjusted
Physician work1.65× 1.0001.6500
Practice expense4.67× 0.9154.2731
Malpractice0.22× 0.3970.0873
Total RVUs6.0104
Conversion factor× 33.4009

Office rate, Iowa$200.75

Office: (1.65 × 1 + 4.67 × 0.915 + 0.22 × 0.397) × $33.4009 = $200.75

Facility: (1.65 × 1 + 1.8 × 0.915 + 0.22 × 0.397) × $33.4009 = $113.04

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, Iowa
Used instead
42100Palate biopsy, tissue samplingBiopsy samples palate or uvula tissue rather than excising the lesion.$137.88
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.$214.01
Same family
42106Palate excision, simple primary closurePalatal or uvular lesion excision with simple repair.$240.59
42107Palatal lesion excision, with complex repairPalatal or uvular lesion excision with extensive repair.$433.04

How 42104 has changed in Iowa

42104 · Office / nonfacility

$200.75

Effective 2026-10-01

The base rate is $7.28 higher than on 2025-10-01, moving from $193.47 to $200.75 (3.8%).

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

    $193.47changed to$200.75

    • 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
    • Practice expense GPCI 0.913 changed to 0.915
    • Malpractice GPCI 0.457 changed to 0.397

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $200.77changed to$193.47

    • 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

    $197.49changed to$200.77

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $203.95changed to$197.49

    • 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
    • Practice expense GPCI 0.910 changed to 0.913
    • Malpractice GPCI 0.441 changed to 0.457

  5. January 1, 2023

    RVU23A

    $205.48changed to$203.95

    • Conversion factor 34.6062 changed to 33.8872
    • Practice expense RVU 4.58 changed to 4.65
    • Practice expense GPCI 0.907 changed to 0.910
    • Malpractice GPCI 0.425 changed to 0.441

    Held through RVU23B, RVU23C, RVU23D.

  6. January 1, 2022

    RVU22A

    $205.77changed to$205.48

    • 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

    $204.78changed to$205.77

    • 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
    • Malpractice GPCI 0.424 changed to 0.425

    Held through RVU21B, RVU21C, RVU21D.

  8. January 1, 2020

    RVU20A

    $203.79changed to$204.78

    • 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
    • Malpractice GPCI 0.423 changed to 0.424

    Held through RVU20B, RVU20C, RVU20D.

  9. January 1, 2019

    RVU19A

    $202.26changed to$203.79

    • 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

    $203.48changed to$202.26

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 4.28 changed to 4.21
    • Practice expense GPCI 0.902 changed to 0.907
    • Malpractice GPCI 0.458 changed to 0.423

    Held through RVU18B, RVU18C, RVU18D.

  11. January 1, 2017

    RVU17A

    $204.65changed to$203.48

    • Conversion factor 35.8043 changed to 35.8887
    • Practice expense RVU 4.35 changed to 4.28
    • Practice expense GPCI 0.896 changed to 0.902
    • Malpractice GPCI 0.493 changed to 0.458

    Held through RVU17B, RVU17C, RVU17D.

  12. January 1, 2016

    RVU16A

    $204.28changed to$204.65

    • 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

    $203.26changed to$204.28

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  14. January 1, 2015

    RVU15A

    $203.92changed to$203.26

    • 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
    • Practice expense GPCI 0.892 changed to 0.896
    • Malpractice GPCI 0.475 changed to 0.493

    Held through RVU15B.

  15. January 1, 2014

    RVU14A

    $205.92changed to$203.92

    • 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
    • Practice expense GPCI 0.887 changed to 0.892
    • Malpractice GPCI 0.456 changed to 0.475

    Held through RVU14B, RVU14C, RVU14D.

  16. January 1, 2013

    RVU13AR

    Earliest loaded release: $205.92

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$200.75$113.04RVU26D
2026-07-01$200.75$113.04RVU26C
2026-04-01$200.75$113.04RVU26B
2026-01-01$200.75$113.04RVU26A
2025-10-01$193.47$122.59RVU25D
2025-07-01$193.47$122.59RVU25C
2025-04-01$193.47$122.59RVU25B
2025-01-01$193.47$122.59RVU25A
2024-10-01$200.77$125.40RVU24D
2024-07-01$200.77$125.40RVU24C
2024-04-01$200.77$125.40RVU24B
2024-03-09$200.77$125.40RVU24AR
2024-01-01$197.49$123.35RVU24A
2023-10-01$203.95$126.24RVU23D
2023-07-01$203.95$126.24RVU23C
2023-04-01$203.95$126.24RVU23B
2023-01-01$203.95$126.24RVU23A
2022-10-01$205.48$126.38RVU22D
2022-07-01$205.48$126.38RVU22C
2022-04-01$205.48$126.38RVU22B
2022-01-01$205.48$126.38RVU22A
2021-10-01$205.77$126.33RVU21D
2021-07-01$205.77$126.33RVU21C
2021-04-01$205.77$126.33RVU21B
2021-01-01$205.77$126.33RVU21A
2020-10-01$204.78$129.50RVU20D
2020-07-01$204.78$129.50RVU20C
2020-04-01$204.78$129.50RVU20B
2020-01-01$204.78$129.50RVU20A
2019-10-01$203.79$131.23RVU19D
2019-07-01$203.79$131.23RVU19C
2019-04-01$203.79$131.23RVU19B
2019-01-01$203.79$131.23RVU19A
2018-10-01$202.26$132.06RVU18D
2018-07-01$202.26$132.06RVU18C
2018-04-01$202.26$132.06RVU18B
2018-01-01$202.26$132.06RVU18AR1
2017-10-01$203.48$132.91RVU17D
2017-07-01$203.48$132.91RVU17C
2017-04-01$203.48$132.91RVU17B
2017-01-01$203.48$132.91RVU17A
2016-10-01$204.65$133.75RVU16D
2016-07-01$204.65$133.75RVU16C
2016-04-01$204.65$133.75RVU16B
2016-01-01$204.65$133.75RVU16A
2015-10-01$204.28$133.77RVU15D
2015-07-01$204.28$133.77RVU15C
2015-04-01$203.26$133.10RVU15B
2015-01-01$203.26$133.10RVU15A
2014-10-01$203.92$132.98RVU14D
2014-07-01$203.92$132.98RVU14C
2014-04-01$203.92$132.98RVU14B
2014-01-01$203.92$132.98RVU14A
2013-10-01$205.92$132.29RVU13D
2013-07-01$205.92$132.29RVU13C
2013-04-01$205.92$132.29RVU13B
2013-01-01$205.92$132.29RVU13AR

Price 42104 for an earlier date of service

Where the Iowa rate applies

Iowa is a Medicare payment area, not a city. Our Census mapping connects it to 1026 cities and communities in Iowa. Some span more than one payment area; confirm with the service ZIP.

  • Ackley
  • Ackworth
  • Adair
  • Adel
  • Afton
  • Agency
  • Ainsworth
  • Akron

Browse all communities in Iowa

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 IowaGPCI2026.csv, line 53 (RVU26D)

Open CMS sourceHow we calculate rates

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