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CPT code 42106: Palate excision, simple primary closure2026 Medicare rate & RVUs in Queens, NY

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.

CMS RVU26DEffective Oct 1, 2026One payment locality465 Medicare services in 2024

In Queens, NY, Medicare pays $303.20 for 42106 in the office and $171.33 when it’s performed in a hospital or facility.

$303.20Office (non-facility)
$171.33Hospital or facility
+15.9%vs the national office rate ($261.53)

Check a contract rate as a % of Medicare · 42106 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 42106 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in Queens, NY
  2. What 42106 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 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.

How Queens, NY compares for 42106

Across 109 of 109 payment localities, the office rate for 42106 runs from $231.44 in Arkansas to $345.67 in San Benito County, CA. Queens, NY pays $303.20. The RVUs are the same everywhere; the geographic indexes change the dollars.

42106 in Queens, NY vs other payment areas
  1. Queens, NY · this page$303.20
  2. Manhattan, NY · New York$300.85−$2.35
  3. NYC suburbs and Long Island, NY · New York$308.21+$5.01
  4. Poughkeepsie and northern NYC suburbs, NY · New York$283.90−$19.30
  5. Rest of New York · New York$249.73−$53.47
  6. Los Angeles, CA · California$294.75−$8.45
  7. Washington, DC area · District of Columbia$298.80−$4.40

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

Every other payment area

42106 in every other Medicare payment locality
Payment localityOfficeFacility
Miami, FLFlorida$282.80$166.66
Chicago, ILIllinois$274.61$162.49
AlaskaAlaska$304.40$185.59
AlabamaAlabama$234.82$137.20
ArkansasArkansas$231.44$135.61
ArizonaArizona$254.58$146.48
Bakersfield, CACalifornia$276.84$154.57
Chico, CACalifornia$276.04$153.78

42106 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.

$231.44

$310.86

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

View every state and territory as a table
42106 office rate range by state
State / territoryOffice rate rangeLocalities
AK$304.401
AL$234.821
AR$231.441
AZ$254.581
CA$276.04–$345.6729
CO$272.071
CT$278.871
DC$298.801
DE$258.781
FL$258.04–$282.803
GA$243.56–$266.472
GU$282.721
HI$282.721
IA$240.591
ID$242.191
IL$250.74–$274.614
IN$243.581
KS$239.551
KY$240.521
LA$240.18–$252.002
MA$270.49–$298.792
MD$263.68–$298.803
ME$243.53–$256.562
MI$246.83–$261.332
MN$260.471
MO$236.13–$252.793
MS$233.831
MT$261.511
NC$246.051
ND$256.171
NE$241.881
NH$267.881
NJ$281.99–$295.742
NM$248.211
NV$260.211
NY$249.73–$308.215
OH$245.741
OK$240.001
OR$258.12–$280.592
PA$246.08–$272.012
PR$263.401
RI$267.911
SC$246.321
SD$255.541
TN$240.761
TX$244.48–$271.228
UT$249.671
VA$255.78–$298.802
VI$263.401
VT$255.251
WA$269.95–$304.782
WI$247.631
WV$241.531
WY$259.181

See 42106 in every payment locality

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

Office or facility?

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.

The exact Queens, NY inputs and CMS source lines

PPRRVU2026_Oct_nonQPP.csv

4,995

Code
42106
Physician work
2.10
Practice expense
5.46
Malpractice
0.27

GPCI2026.csv

81

Locality
Queens, NY
Physician work
1.064
Practice expense
1.182
Malpractice
1.442
Office calculation for 42106 in Queens, NY
ComponentRVULocality factorAdjusted
Physician work2.10× 1.0642.2344
Practice expense5.46× 1.1826.4537
Malpractice0.27× 1.4420.3893
Total RVUs9.0775
Conversion factor× 33.4009

Office rate, Queens, NY$303.20

Office: (2.1 × 1.064 + 5.46 × 1.182 + 0.27 × 1.442) × $33.4009 = $303.20

Facility: (2.1 × 1.064 + 2.12 × 1.182 + 0.27 × 1.442) × $33.4009 = $171.33

Open 42106 in the RVU calculator

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

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 · 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.

SurgeryVisit
Sep 28, 2026Oct 14, 2026

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%).

When to use modifier 51

Codes related to 42106

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

Codes related to 42106
CodeHow it relatesOffice range, Queens, NY
Used instead
42100Palate biopsy, tissue samplingPalate or uvula biopsy is used for diagnostic sampling rather than lesion excision with simple closure.$173.59
42120Palate resection, extensive lesion or palateConsider for palate resection or a more extensive palate lesion procedure rather than a limited excision with simple closure.No office rate
Same family
42104Palatal excision, without closureSibling excision code for a palate or uvula lesion when the site is left without closure.$253.61
42107Palatal lesion excision, with complex repairSibling excision code for a palate or uvula lesion closed with a local flap.$543.86

How 42106 has changed in Queens, NY

42106 · Office / nonfacility

$303.20

Effective 2026-10-01

The base rate is $17.56 higher than on 2025-10-01, moving from $285.64 to $303.20 (6.1%).

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

    $285.64changed to$303.20

    • Conversion factor 32.3465 changed to 33.4009
    • Work RVU 2.15 changed to 2.10
    • Practice expense RVU 5.18 changed to 5.46
    • Malpractice RVU 0.24 changed to 0.27
    • Work GPCI 1.065 changed to 1.064
    • Practice expense GPCI 1.195 changed to 1.182
    • Malpractice GPCI 1.462 changed to 1.442

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $292.76changed to$285.64

    • Conversion factor 33.2875 changed to 32.3465
    • Practice expense RVU 5.15 changed to 5.18

    Held through RVU25B, RVU25C, RVU25D.

  3. March 9, 2024

    RVU24AR

    $287.98changed to$292.76

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $310.80changed to$287.98

    • Conversion factor 33.8872 changed to 32.7442
    • Practice expense RVU 5.26 changed to 5.15
    • Malpractice RVU 0.25 changed to 0.24
    • Work GPCI 1.061 changed to 1.065
    • Practice expense GPCI 1.212 changed to 1.195
    • Malpractice GPCI 2.061 changed to 1.462

  5. January 1, 2023

    RVU23A

    $327.60changed to$310.80

    • Conversion factor 34.6062 changed to 33.8872
    • Practice expense RVU 5.34 changed to 5.26
    • Malpractice RVU 0.24 changed to 0.25
    • Work GPCI 1.056 changed to 1.061
    • Practice expense GPCI 1.228 changed to 1.212
    • Malpractice GPCI 2.661 changed to 2.061

    Held through RVU23B, RVU23C, RVU23D.

  6. January 1, 2022

    RVU22A

    $332.32changed to$327.60

    • Conversion factor 34.8931 changed to 34.6062
    • Practice expense RVU 5.43 changed to 5.34
    • Malpractice RVU 0.22 changed to 0.24

    Held through RVU22B, RVU22C, RVU22D.

  7. January 1, 2021

    RVU21A

    $331.21changed to$332.32

    • Conversion factor 36.0896 changed to 34.8931
    • Practice expense RVU 5.24 changed to 5.43
    • Malpractice RVU 0.23 changed to 0.22
    • Work GPCI 1.054 changed to 1.056
    • Practice expense GPCI 1.214 changed to 1.228
    • Malpractice GPCI 2.391 changed to 2.661

    Held through RVU21B, RVU21C, RVU21D.

  8. January 1, 2020

    RVU20A

    $337.04changed to$331.21

    • Conversion factor 36.0391 changed to 36.0896
    • Practice expense RVU 5.29 changed to 5.24
    • Malpractice RVU 0.35 changed to 0.23
    • Work GPCI 1.052 changed to 1.054
    • Practice expense GPCI 1.200 changed to 1.214
    • Malpractice GPCI 2.121 changed to 2.391

    Held through RVU20B, RVU20C, RVU20D.

  9. January 1, 2019

    RVU19A

    $340.23changed to$337.04

    • Conversion factor 35.9996 changed to 36.0391
    • Practice expense RVU 5.39 changed to 5.29
    • Malpractice RVU 0.34 changed to 0.35

    Held through RVU19B, RVU19C, RVU19D.

  10. January 1, 2018

    RVU18AR1

    $342.90changed to$340.23

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 5.45 changed to 5.39
    • Malpractice RVU 0.35 changed to 0.34
    • Malpractice GPCI 2.151 changed to 2.121

    Held through RVU18B, RVU18C, RVU18D.

  11. January 1, 2017

    RVU17A

    $344.85changed to$342.90

    • Conversion factor 35.8043 changed to 35.8887
    • Practice expense RVU 5.51 changed to 5.45
    • Practice expense GPCI 1.199 changed to 1.200
    • Malpractice GPCI 2.181 changed to 2.151

    Held through RVU17B, RVU17C, RVU17D.

  12. January 1, 2016

    RVU16A

    $344.45changed to$344.85

    • Conversion factor 35.9335 changed to 35.8043
    • Practice expense RVU 5.49 changed to 5.51
    • Malpractice RVU 0.34 changed to 0.35

    Held through RVU16B, RVU16C, RVU16D.

  13. July 1, 2015

    RVU15C

    $342.74changed to$344.45

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  14. January 1, 2015

    RVU15A

    $335.66changed to$342.74

    • Conversion factor 35.8228 changed to 35.7547
    • Practice expense RVU 5.50 changed to 5.49
    • Malpractice RVU 0.28 changed to 0.34
    • Work GPCI 1.057 changed to 1.052
    • Practice expense GPCI 1.197 changed to 1.199
    • Malpractice GPCI 1.836 changed to 2.181

    Held through RVU15B.

  15. January 1, 2014

    RVU14A

    $336.75changed to$335.66

    • Conversion factor 34.0230 changed to 35.8228
    • Practice expense RVU 6.01 changed to 5.50
    • Malpractice RVU 0.29 changed to 0.28
    • Work GPCI 1.062 changed to 1.057
    • Practice expense GPCI 1.195 changed to 1.197
    • Malpractice GPCI 1.491 changed to 1.836

    Held through RVU14B, RVU14C, RVU14D.

  16. January 1, 2013

    RVU13AR

    Earliest loaded release: $336.75

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$303.20$171.33RVU26D
2026-07-01$303.20$171.33RVU26C
2026-04-01$303.20$171.33RVU26B
2026-01-01$303.20$171.33RVU26A
2025-10-01$285.64$182.05RVU25D
2025-07-01$285.64$182.05RVU25C
2025-04-01$285.64$182.05RVU25B
2025-01-01$285.64$182.05RVU25A
2024-10-01$292.76$184.96RVU24D
2024-07-01$292.76$184.96RVU24C
2024-04-01$292.76$184.96RVU24B
2024-03-09$292.76$184.96RVU24AR
2024-01-01$287.98$181.94RVU24A
2023-10-01$310.80$195.80RVU23D
2023-07-01$310.80$195.80RVU23C
2023-04-01$310.80$195.80RVU23B
2023-01-01$310.80$195.80RVU23A
2022-10-01$327.60$204.36RVU22D
2022-07-01$327.60$204.36RVU22C
2022-04-01$327.60$204.36RVU22B
2022-01-01$327.60$204.36RVU22A
2021-10-01$332.32$205.91RVU21D
2021-07-01$332.32$205.91RVU21C
2021-04-01$332.32$205.91RVU21B
2021-01-01$332.32$205.91RVU21A
2020-10-01$331.21$210.29RVU20D
2020-07-01$331.21$210.29RVU20C
2020-04-01$331.21$210.29RVU20B
2020-01-01$331.21$210.29RVU20A
2019-10-01$337.04$218.98RVU19D
2019-07-01$337.04$218.98RVU19C
2019-04-01$337.04$218.98RVU19B
2019-01-01$337.04$218.98RVU19A
2018-10-01$340.23$223.16RVU18D
2018-07-01$340.23$223.16RVU18C
2018-04-01$340.23$223.16RVU18B
2018-01-01$340.23$223.16RVU18AR1
2017-10-01$342.90$225.76RVU17D
2017-07-01$342.90$225.76RVU17C
2017-04-01$342.90$225.76RVU17B
2017-01-01$342.90$225.76RVU17A
2016-10-01$344.85$226.80RVU16D
2016-07-01$344.85$226.80RVU16C
2016-04-01$344.85$226.80RVU16B
2016-01-01$344.85$226.80RVU16A
2015-10-01$344.45$226.83RVU15D
2015-07-01$344.45$226.83RVU15C
2015-04-01$342.74$225.70RVU15B
2015-01-01$342.74$225.70RVU15A
2014-10-01$335.66$218.60RVU14D
2014-07-01$335.66$218.60RVU14C
2014-04-01$335.66$218.60RVU14B
2014-01-01$335.66$218.60RVU14A
2013-10-01$336.75$214.37RVU13D
2013-07-01$336.75$214.37RVU13C
2013-04-01$336.75$214.37RVU13B
2013-01-01$336.75$214.37RVU13AR

Price 42106 for an earlier date of service

Where the Queens, NY rate applies

Queens, NY is a Medicare payment area, not a city. Our Census mapping connects it to 1 cities and communities in New York. Some span more than one payment area; confirm with the service ZIP.

Browse all communities in New York

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
RVUs for 42106PPRRVU2026_Oct_nonQPP.csv, line 4,995 (RVU26D)
Geographic factors for Queens, NYGPCI2026.csv, line 81 (RVU26D)

Open CMS sourceHow we calculate rates

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