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CPT code 42107: Palatal lesion excision, with complex repair2026 Medicare rate & RVUs in Puerto Rico

Reports removal of a lesion of the palate or uvula when the excision is followed by complex repair of the resulting site.

CMS RVU26DEffective Oct 1, 2026One payment locality132 Medicare services in 2024

In Puerto Rico, Medicare pays $473.65 for 42107 in the office and $305.82 when it’s performed in a hospital or facility.

$473.65Office (non-facility)
$305.82Hospital or facility
+0.6%vs the national office rate ($470.62)

Check a contract rate as a % of Medicare · 42107 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 42107 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in Puerto Rico
  2. What 42107 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 42107 covers

An otolaryngologist, oral and maxillofacial surgeon, or other qualified surgeon may use this code to remove a lesion from the palate or uvula and perform complex repair of the excision site. The service may occur in an office or facility setting; the operative record should identify the lesion site, the excision, and the repair performed.

Choose this code when the documented repair is complex, rather than the simpler repair levels represented by sibling codes. The removal and complex repair are reported together, not as separate excision and closure services. Medicare assigns a 90-day global period, which includes the day-before preoperative visit and 90 days of related postoperative care. 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% reduction. Modifier 50 is inappropriate. Medicare does not pay an assistant at surgery, and 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 Puerto Rico compares for 42107

Across 109 of 109 payment localities, the office rate for 42107 runs from $418.44 in Arkansas to $611.43 in San Benito County, CA. Puerto Rico pays $473.65. The RVUs are the same everywhere; the geographic indexes change the dollars.

42107 in Puerto Rico vs other payment areas
  1. Puerto Rico · this page$473.65
  2. Los Angeles, CA · California$525.41+$51.76
  3. Washington, DC area · District of Columbia$534.68+$61.03
  4. Miami, FL · Florida$513.14+$39.49
  5. Chicago, IL · Illinois$498.69+$25.04
  6. Manhattan, NY · New York$540.65+$67.00
  7. Alaska · Alaska$555.74+$82.09

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

Every other payment area

42107 in every other Medicare payment locality
Payment localityOfficeFacility
AlabamaAlabama$424.28$279.03
ArkansasArkansas$418.44$275.84
ArizonaArizona$458.41$297.55
Bakersfield, CACalifornia$494.76$312.82
Chico, CACalifornia$493.02$311.08
El Centro, CACalifornia$493.12$311.18
Fresno, CACalifornia$493.02$311.08
Hanford, CACalifornia$493.02$311.08

42107 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.

$418.44

$555.74

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

View every state and territory as a table
42107 office rate range by state
State / territoryOffice rate rangeLocalities
AK$555.741
AL$424.281
AR$418.441
AZ$458.411
CA$493.02–$611.4329
CO$487.431
CT$501.011
DC$534.681
DE$465.741
FL$467.23–$513.143
GA$441.76–$479.862
GU$503.731
HI$503.731
IA$433.041
ID$436.051
IL$455.42–$498.694
IN$438.421
KS$431.831
KY$435.391
LA$435.03–$455.462
MA$485.02–$533.192
MD$474.12–$534.683
ME$438.99–$460.632
MI$446.86–$473.562
MN$465.511
MO$428.39–$456.153
MS$423.461
MT$470.581
NC$443.251
ND$458.911
NE$435.091
NH$480.551
NJ$506.29–$529.692
NM$449.491
NV$467.631
NY$449.65–$554.155
OH$444.481
OK$433.881
OR$463.56–$501.502
PA$444.75–$489.492
PR$473.651
RI$481.291
SC$444.691
SD$457.531
TN$433.991
TX$442.01–$486.208
UT$450.471
VA$459.69–$534.682
VI$473.651
VT$457.861
WA$483.86–$543.062
WI$444.291
WV$439.511
WY$465.491

See 42107 in every payment locality

How the 42107 rate is calculated

Each of 42107’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 · 42107

RVUs × geographic indexes × conversion factor

Office or facility?

Work4.45

4.45 RVUs× 1.000 GPCI

Practice expense9.05

9.05 RVUs× 1.000 GPCI

Malpractice0.59

0.59 RVUs× 1.000 GPCI

Adjusted RVUs

14.0900

Conversion factor

$33.4009

Medicare rate

$470.62

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

The exact Puerto Rico inputs and CMS source lines

PPRRVU2026_Oct_nonQPP.csv

4,996

Code
42107
Physician work
4.45
Practice expense
9.05
Malpractice
0.59

GPCI2026.csv

91

Locality
Puerto Rico
Physician work
1.000
Practice expense
1.011
Malpractice
0.985
Office calculation for 42107 in Puerto Rico
ComponentRVULocality factorAdjusted
Physician work4.45× 1.0004.4500
Practice expense9.05× 1.0119.1495
Malpractice0.59× 0.9850.5811
Total RVUs14.1807
Conversion factor× 33.4009

Office rate, Puerto Rico$473.65

Office: (4.45 × 1 + 9.05 × 1.011 + 0.59 × 0.985) × $33.4009 = $473.65

Facility: (4.45 × 1 + 4.08 × 1.011 + 0.59 × 0.985) × $33.4009 = $305.82

Open 42107 in the RVU calculator

Payment rules and modifiers for 42107

42107 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 42107

Palatal lesion excision, with complex repair

RuleCMS valueWhat it means
Global period090Major surgery: the day before, the day of, and 90 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)0.09/0.81/0.10Share of the payment for pre-op, the procedure itself, and post-op care.

Global surgery period · 42107

Palatal lesion excision, with complex repair

90-day global period ends

Dec 30, 2026

Covers Sep 30, 2026 through Dec 30, 2026 (92 days, including the day before surgery).

Visit on Oct 31, 2026

Day 30 of the 90-day post-op period: related follow-up care is included in the surgical payment.

  • 24Unrelated E/M visit by the same physician
  • 79Unrelated procedure (starts its own global period)
  • 58Staged, more extensive, or therapy procedure that was planned
  • 78Unplanned return to the operating room for a related complication
SurgeryVisit
Sep 23, 2026Jan 10, 2027

Pre-op dayGlobal period

What modifiers do to the payment

Modifier 51 · payment effect

With and without the modifier

42107 without 51 · national office

$470.62

Palatal lesion excision, with complex repair

42107-51 · Second procedure: 50%

$235.31

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 42107

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

Codes related to 42107
CodeHow it relatesOffice range, Puerto Rico
Same family
42104Palatal excision, without closurePalate or uvula lesion excision at the level without closure.$220.05
42106Palate excision, simple primary closurePalate or uvula lesion excision with simple repair.$263.40
Used instead
42100Palate biopsy, tissue samplingBiopsy of a palate or uvula lesion rather than excision with complex repair.$150.97
42120Palate resection, extensive lesion or palateUsed for palate resection or extensive lesion resection, a different extent of service.No office rate

How 42107 has changed in Puerto Rico

42107 · Office / nonfacility

$473.65

Effective 2026-10-01

The base rate is $36.01 higher than on 2025-10-01, moving from $437.64 to $473.65 (8.2%).

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

    $437.64changed to$473.65

    • Conversion factor 32.3465 changed to 33.4009
    • Work RVU 4.56 changed to 4.45
    • Practice expense RVU 8.41 changed to 9.05
    • Malpractice RVU 0.51 changed to 0.59
    • Practice expense GPCI 1.007 changed to 1.011
    • Malpractice GPCI 0.982 changed to 0.985

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $446.35changed to$437.64

    • Conversion factor 33.2875 changed to 32.3465
    • Practice expense RVU 8.29 changed to 8.41

    Held through RVU25B, RVU25C, RVU25D.

  3. March 9, 2024

    RVU24AR

    $439.06changed to$446.35

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $464.24changed to$439.06

    • Conversion factor 33.8872 changed to 32.7442
    • Practice expense RVU 8.53 changed to 8.29
    • Malpractice RVU 0.55 changed to 0.51
    • Practice expense GPCI 1.008 changed to 1.007
    • Malpractice GPCI 0.984 changed to 0.982

  5. October 1, 2023

    RVU23D

    $462.22changed to$464.24

    • Practice expense GPCI 1.000 changed to 1.008
    • Malpractice GPCI 1.000 changed to 0.984

  6. January 1, 2023

    RVU23A

    $477.61changed to$462.22

    • Conversion factor 34.6062 changed to 33.8872
    • Practice expense RVU 8.63 changed to 8.53
    • Practice expense GPCI 1.008 changed to 1.000
    • Malpractice GPCI 0.986 changed to 1.000

    Held through RVU23B, RVU23C.

  7. January 1, 2022

    RVU22A

    $486.86changed to$477.61

    • Conversion factor 34.8931 changed to 34.6062
    • Practice expense RVU 8.79 changed to 8.63
    • Malpractice RVU 0.54 changed to 0.55

    Held through RVU22B, RVU22C, RVU22D.

  8. January 1, 2021

    RVU21A

    $481.03changed to$486.86

    • Conversion factor 36.0896 changed to 34.8931
    • Practice expense RVU 8.17 changed to 8.79
    • Malpractice GPCI 0.988 changed to 0.986

    Held through RVU21B, RVU21C, RVU21D.

  9. January 1, 2020

    RVU20A

    $483.27changed to$481.03

    • Conversion factor 36.0391 changed to 36.0896
    • Practice expense RVU 8.10 changed to 8.17
    • Malpractice RVU 0.70 changed to 0.54
    • Practice expense GPCI 1.007 changed to 1.008
    • Malpractice GPCI 0.990 changed to 0.988

    Held through RVU20B, RVU20C, RVU20D.

  10. January 1, 2019

    RVU19A

    $479.11changed to$483.27

    • Conversion factor 35.9996 changed to 36.0391
    • Practice expense RVU 7.99 changed to 8.10
    • Malpractice RVU 0.71 changed to 0.70

    Held through RVU19B, RVU19C, RVU19D.

  11. January 1, 2018

    RVU18AR1

    $428.62changed to$479.11

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 8.10 changed to 7.99
    • Malpractice RVU 0.70 changed to 0.71
    • Practice expense GPCI 0.856 changed to 1.007
    • Malpractice GPCI 0.642 changed to 0.990

    Held through RVU18B, RVU18C, RVU18D.

  12. January 1, 2017

    RVU17A

    $378.46changed to$428.62

    • Conversion factor 35.8043 changed to 35.8887
    • Practice expense RVU 8.23 changed to 8.10
    • Malpractice RVU 0.71 changed to 0.70
    • Practice expense GPCI 0.705 changed to 0.856
    • Malpractice GPCI 0.293 changed to 0.642

    Held through RVU17B, RVU17C, RVU17D.

  13. January 1, 2016

    RVU16A

    $377.29changed to$378.46

    • Conversion factor 35.9335 changed to 35.8043
    • Practice expense RVU 8.13 changed to 8.23

    Held through RVU16B, RVU16C, RVU16D.

  14. July 1, 2015

    RVU15C

    $375.41changed to$377.29

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  15. January 1, 2015

    RVU15A

    $372.81changed to$375.41

    • Conversion factor 35.8228 changed to 35.7547
    • Practice expense RVU 8.23 changed to 8.13
    • Malpractice RVU 0.56 changed to 0.71
    • Practice expense GPCI 0.692 changed to 0.705
    • Malpractice GPCI 0.271 changed to 0.293

    Held through RVU15B.

  16. January 1, 2014

    RVU14A

    $369.37changed to$372.81

    • Conversion factor 34.0230 changed to 35.8228
    • Practice expense RVU 9.07 changed to 8.23
    • Malpractice RVU 0.59 changed to 0.56
    • Practice expense GPCI 0.678 changed to 0.692
    • Malpractice GPCI 0.249 changed to 0.271

    Held through RVU14B, RVU14C, RVU14D.

  17. January 1, 2013

    RVU13AR

    Earliest loaded release: $369.37

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$473.65$305.82RVU26D
2026-07-01$473.65$305.82RVU26C
2026-04-01$473.65$305.82RVU26B
2026-01-01$473.65$305.82RVU26A
2025-10-01$437.64$320.70RVU25D
2025-07-01$437.64$320.70RVU25C
2025-04-01$437.64$320.70RVU25B
2025-01-01$437.64$320.70RVU25A
2024-10-01$446.35$325.00RVU24D
2024-07-01$446.35$325.00RVU24C
2024-04-01$446.35$325.00RVU24B
2024-03-09$446.35$325.00RVU24AR
2024-01-01$439.06$319.70RVU24A
2023-10-01$464.24$334.43RVU23D
2023-07-01$462.22$333.45RVU23C
2023-04-01$462.22$333.45RVU23B
2023-01-01$462.22$333.45RVU23A
2022-10-01$477.61$340.52RVU22D
2022-07-01$477.61$340.52RVU22C
2022-04-01$477.61$340.52RVU22B
2022-01-01$477.61$340.52RVU22A
2021-10-01$486.86$344.76RVU21D
2021-07-01$486.86$344.76RVU21C
2021-04-01$486.86$344.76RVU21B
2021-01-01$486.86$344.76RVU21A
2020-10-01$481.03$352.25RVU20D
2020-07-01$481.03$352.25RVU20C
2020-04-01$481.03$352.25RVU20B
2020-01-01$481.03$352.25RVU20A
2019-10-01$483.27$359.16RVU19D
2019-07-01$483.27$359.16RVU19C
2019-04-01$483.27$359.16RVU19B
2019-01-01$483.27$359.16RVU19A
2018-10-01$479.11$360.57RVU18D
2018-07-01$479.11$360.57RVU18C
2018-04-01$479.11$360.57RVU18B
2018-01-01$479.11$360.57RVU18AR1
2017-10-01$428.62$327.85RVU17D
2017-07-01$428.62$327.85RVU17C
2017-04-01$428.62$327.85RVU17B
2017-01-01$428.62$327.85RVU17A
2016-10-01$378.46$294.91RVU16D
2016-07-01$378.46$294.91RVU16C
2016-04-01$378.46$294.91RVU16B
2016-01-01$378.46$294.91RVU16A
2015-10-01$377.29$293.69RVU15D
2015-07-01$377.29$293.69RVU15C
2015-04-01$375.41$292.23RVU15B
2015-01-01$375.41$292.23RVU15A
2014-10-01$372.81$291.50RVU14D
2014-07-01$372.81$291.50RVU14C
2014-04-01$372.81$291.50RVU14B
2014-01-01$372.81$291.50RVU14A
2013-10-01$369.37$284.48RVU13D
2013-07-01$369.37$284.48RVU13C
2013-04-01$369.37$284.48RVU13B
2013-01-01$369.37$284.48RVU13AR

Price 42107 for an earlier date of service

Where the Puerto Rico rate applies

Puerto Rico is a Medicare payment area, not a city. Our Census mapping connects it to 292 cities and communities in Puerto Rico. Some span more than one payment area; confirm with the service ZIP.

  • Aceitunas
  • Adjuntas
  • Aguada
  • Aguadilla
  • Aguas Buenas
  • Aguas Claras
  • Aguilita
  • Aibonito

Browse all communities in Puerto Rico

42107 billing questions

How does this differ from 42106?

42107 is for lesion excision with complex repair; 42106 represents the simple-repair level. The operative note should support the repair level reported.

Can the excision and repair be billed separately?

No. Complex repair is included in 42107; do not report a separate closure service for that repair.

When should 42100 be used instead?

42100 is for biopsy of a palate or uvula lesion. Use 42107 when the service is excision with complex repair rather than a biopsy.

Should modifier 50 be appended for lesions on both sides?

No. CMS identifies bilateral adjustment as inappropriate for this code, so modifier 50 should not be used.

What postoperative care is included?

The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.

Can an assistant or co-surgeon be reported?

Medicare does not pay an assistant at surgery for this service. Co-surgeons and team surgery 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 42107PPRRVU2026_Oct_nonQPP.csv, line 4,996 (RVU26D)
Geographic factors for Puerto RicoGPCI2026.csv, line 91 (RVU26D)

Open CMS sourceHow we calculate rates

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