CPT code 42145: Palatopharyngoplasty, palate and pharynx repair2026 Medicare rate & RVUs

Medicare pays $608.56 for 42145 nationally in a facility.

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

What 42145 covers

An otolaryngologist performs palatopharyngoplasty to reshape soft-palate and pharyngeal tissues, often including the uvula, to enlarge or stabilize the upper airway. Uvulopalatopharyngoplasty is a familiar example. The service is typically performed in an operating room for a patient with obstructive sleep apnea or another documented airway problem; it is more extensive than removing the uvula alone.

Report the code when the operative work includes reconstruction of the palate-pharynx region, not simply removal of a lesion or repair of an acute laceration. The operative report should describe the tissues addressed and the reconstructive work performed. Medicare assigns a 90-day global period, including the day-before preoperative visit and related postoperative care during that period. For multiple procedures 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-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 42145 pays more and less

The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.

109 of 109 payment localities

42145 rates by state

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

How the 42145 rate is calculated

Each of 42145’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 42145

42145 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

42145 compared with similar codes

How to choose

42140Uvula excisionExcision of uvula

Use 42140 for excision limited to the uvula. Use 42145 when the surgeon reshapes the soft palate and pharyngeal tissues as well.

42120Palate resectionExtensive lesion or palate

Code 42120 addresses resection of the palate or a palate lesion. Code 42145 describes palatopharyngeal reshaping for an airway problem, not lesion removal.

42180Palate repairLaceration under 2 cm

Code 42180 is for repair of a small traumatic palate laceration. Code 42145 is reconstructive airway surgery, not acute wound repair.

42950PharyngoplastyReconstruction of the pharynx

Code 42950 describes pharyngeal plastic surgery. Distinguish it from 42145 by the documented operative site and reconstruction; 42145 specifically addresses the palate-pharynx region, often for airway obstruction.

Codes related to 42145

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

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