CPT code 42106: Palate excision, simple primary closure2026 Medicare rate & RVUs in Missouri
Removal of a lesion on the palate or uvula followed by simple primary closure, selected when the operative technique does not require a local flap.
Medicare pays $236.13–$252.79 for 42106 in the office in Missouri, from Rest of Missouri to Metropolitan St. Louis, MO. 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 42106 covers
This service removes a lesion from the palate or uvula and closes the resulting wound with a simple primary closure. It is typically performed by an otolaryngologist or oral and maxillofacial surgeon in an office or facility setting. The lesion may be submitted for pathologic examination; the code choice follows the operative method of removal and closure, not the eventual pathology result.
Report this code when the surgeon excises the lesion and closes the site directly without a local flap. The operative note should identify the palate or uvula site, describe the excision and closure, and distinguish simple closure from closure using a flap. CMS assigns a 10-day global period, including related postoperative visits during that interval. When other procedures are performed in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard multiple-procedure reduction. Modifier 50 is inappropriate for this code. Medicare does not pay an assistant at surgery for this service; co-surgeons and team surgery 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 42106 pays more and less in Missouri
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
3 payment localities
$236.13 to $252.79
| Payment locality | Office | Facility |
|---|---|---|
| Metropolitan Kansas City, MO | $250.20 | $145.44 |
| Metropolitan St. Louis, MO | $252.79 | $146.59 |
| Rest of Missouri | $236.13 | $139.96 |
How the 42106 rate is calculated
Each of 42106’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 · 42106
RVUs × geographic indexes × conversion factor
Work2.10
2.10 RVUs× 1.000 GPCI
Practice expense5.46
5.46 RVUs× 1.000 GPCI
Malpractice0.27
0.27 RVUs× 1.000 GPCI
Adjusted RVUs
7.8300
Conversion factor
$33.4009
Medicare rate
$261.53
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 42106
42106 has a 10-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 42106
Palate excision, simple primary 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 · 42106
Palate excision, simple primary 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
42106 without 51 · national office
$261.53
Palate excision, simple primary closure
42106-51 · Second procedure: 50%
$130.77
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%).
42106 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 42100Palate biopsyTissue sampling
- 42100 reports biopsy for diagnostic sampling. Choose 42106 when the lesion is excised and the wound receives a simple primary closure.
- 42104Palatal excisionWithout closure
- 42104 applies when the excision site is left without closure; 42106 applies when it is directly closed.
- 42107Palatal lesion excisionWith complex repair
- 42107 includes closure with a local flap. A simple direct closure after excision supports 42106.
- 42120Palate resectionExtensive lesion or palate
- 42120 concerns palate resection or a more extensive palate lesion procedure. 42106 is for lesion excision with simple primary closure.
42106 billing questions
How does this code differ from 42104?
42106 is used when the excision site receives a simple primary closure. 42104 describes excision without closure.
When is 42107 more appropriate?
Use 42107 when the surgeon closes the defect with a local flap. A direct simple closure supports 42106 instead.
Can a biopsy code be reported for the same lesion?
42100 describes biopsy of a palate or uvula site, rather than excision with simple closure. The operative documentation should support the service actually performed.
Is modifier 50 appropriate for lesions on both sides?
No. CMS identifies bilateral adjustment as inappropriate for this code; modifier 50 should not be used to report it as a bilateral procedure.
What postoperative care is included?
Related postoperative visits for 10 days are included in the global period.
How are other procedures in the same session paid?
The highest-valued procedure is paid in full, and other procedures are subject to the standard multiple-procedure reduction.
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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