CPT code 42120: Palate resection, extensive lesion or palate2026 Medicare rate & RVUs in Washington, DC area

In Washington, DC area, Medicare pays $1,023.00 for 42120 in a facility. There’s no office rate.

Check a contract rate as a % of Medicare · 42120 nationwide

Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.

What 42120 covers

An otolaryngologist or oral and maxillofacial surgeon reports this service when surgery removes a substantial portion of the palate or requires extensive excision of a palatal lesion. It is typically performed in an operating room, often for a sizable tumor or other lesion whose extent calls for more than a localized excision. The resected tissue may be submitted for pathologic examination.

Choose this code based on the operative extent and tissue removed, not the lesion diagnosis alone. The operative report should describe the palatal site, lesion extent, amount of tissue resected, and surgical work performed; limited lesion excision belongs to the more specific excision codes when their criteria are met. Medicare assigns a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. For multiple procedures in one session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% reduction. Bilateral adjustment is inappropriate. Assistant-at-surgery payment may be available; co-surgeon payment requires supporting documentation, and team surgery is 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 Washington, DC area compares for 42120

Across 109 of 109 payment localities, the facility rate for 42120 runs from $818.59 in Arkansas to $1,136.03 in San Benito County, CA. Washington, DC area pays $1,023.00. The RVUs are the same everywhere; the geographic indexes change the dollars.

Every other payment area

42120 rates by state

Office rate range in each state. Select a state to see its payment localities.

See 42120 in every payment locality

How the 42120 rate is calculated

Each of 42120’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.

Payment rules and modifiers for 42120

42120 has a 90-day global period: related visits in that window are included in the surgery payment.

What modifiers do to the payment

When to use modifier 51

Codes related to 42120

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

How 42120 has changed in Washington, DC area

Price 42120 for an earlier date of service

Where the Washington, DC area rate applies

Washington, DC area is a Medicare payment area, not a city. Our Census mapping connects it to 1 cities and communities in District of Columbia. Some span more than one payment area; confirm with the service ZIP.

• Washington

Browse all communities in District of Columbia

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

Open CMS sourceHow we calculate rates