CPT code 42104: Palatal excision, without closure2026 Medicare rate & RVUs in Texas
Report this service when a clinician excises a lesion of the palate or uvula without closing the resulting site.
Medicare pays $203.88–$226.76 for 42104 in the office in Texas, from Beaumont, TX to Austin, TX. 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.
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On this page 9 sections
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 in Texas
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
8 payment localities
$203.88 to $226.76
8 of 8 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Austin, TX | $226.76 | $125.34 |
| Beaumont, TX | $203.88 | $116.65 |
| Brazoria, TX | $215.86 | $120.86 |
| Dallas, TX | $217.27 | $121.79 |
| Fort Worth, TX | $215.81 | $121.29 |
| Galveston, TX | $216.53 | $121.34 |
| Houston, TX | $220.55 | $125.36 |
| Rest of Texas | $209.77 | $118.80 |
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
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.
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
| 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 · 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.
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%).
42104 compared with similar codes
Compare codes · National
5 codes, side by side
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.
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
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