CPT code 42160: Palate lesion treatment, destruction method2026 Medicare rate & RVUs in Merced, CA
Reports destruction of a lesion on the palate or uvula, such as treatment using laser or cautery rather than biopsy or excision.
In Merced, CA, Medicare pays $245.92 for 42160 in the office and $132.44 when it’s performed in a hospital or facility.
Check a contract rate as a % of Medicare · 42160 nationwide
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
On this page 11 sections
What 42160 covers
This service destroys a lesion on the roof of the mouth or uvula, using a method such as laser or cautery. Otolaryngologists and oral surgeons may perform it in an office or operating room when the treatment plan is to destroy the lesion rather than remove tissue for examination or excise it surgically. The site and treatment method distinguish this service from biopsy and excision codes for the same area.
Document the lesion’s location and the destruction performed. The code has a 10-day global period, so related postoperative visits during that period are included. 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% multiple-procedure reduction. Modifier 50 is inappropriate for this service. Assistant-at-surgery payment requires documented medical necessity; 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 Merced, CA compares for 42160
Across 109 of 109 payment localities, the office rate for 42160 runs from $205.64 in Arkansas to $308.60 in San Benito County, CA. Merced, CA pays $245.92. The RVUs are the same everywhere; the geographic indexes change the dollars.
- Merced, CA · this page$245.92
- Bakersfield, CA · California$246.58+$0.66
- Chico, CA · California$245.92
- El Centro, CA · California$245.96+$0.04
- Fresno, CA · California$245.92
- Hanford, CA · California$245.92
- Los Angeles, CA · California$262.66+$16.74
Other areas in California first, then benchmark localities. Bars start at $0.
Every other payment area
| Payment locality | Office | Facility |
|---|---|---|
| Madera, CACalifornia | $245.92 | $132.44 |
| Modesto, CACalifornia | $245.92 | $132.44 |
| Napa, CACalifornia | $285.11 | $148.64 |
| Oxnard, CACalifornia | $261.41 | $139.03 |
| Redding, CACalifornia | $245.92 | $132.44 |
| Rest of CaliforniaCalifornia | $245.92 | $132.44 |
| Riverside, CACalifornia | $248.31 | $134.83 |
| Sacramento, CACalifornia | $258.12 | $137.70 |
| Salinas, CACalifornia | $257.16 | $137.15 |
| San Diego, CACalifornia | $263.25 | $139.41 |
| Marin County, CACalifornia | $301.86 | $155.86 |
| San Francisco, CACalifornia | $301.61 | $155.61 |
| San Benito County, CACalifornia | $308.60 | $159.30 |
| Santa Clara County, CACalifornia | $307.58 | $158.27 |
| San Luis Obispo, CACalifornia | $253.02 | $135.08 |
| Santa Cruz, CACalifornia | $265.80 | $139.99 |
| Santa Maria, CACalifornia | $258.13 | $137.40 |
| Santa Rosa, CACalifornia | $268.48 | $141.33 |
| Stockton, CACalifornia | $245.92 | $132.44 |
| Vallejo, CACalifornia | $284.75 | $148.28 |
| Visalia, CACalifornia | $245.92 | $132.44 |
| Yuba City, CACalifornia | $245.92 | $132.44 |
| Washington, DC areaDistrict of Columbia | $265.92 | $143.94 |
| Miami, FLFlorida | $250.47 | $142.68 |
| Chicago, ILIllinois | $243.23 | $139.17 |
| Manhattan, NYNew York | $267.35 | $147.04 |
| AlaskaAlaska | $269.96 | $159.68 |
| AlabamaAlabama | $208.66 | $118.06 |
| ArkansasArkansas | $205.64 | $116.70 |
| ArizonaArizona | $226.30 | $125.96 |
| ColoradoColorado | $242.14 | $131.97 |
| ConnecticutConnecticut | $247.92 | $136.41 |
| DelawareDelaware | $230.05 | $127.75 |
| Fort Lauderdale, FLFlorida | $240.55 | $135.66 |
| Rest of FloridaFlorida | $228.91 | $129.92 |
| Atlanta, GAGeorgia | $236.77 | $131.57 |
| Rest of GeorgiaGeorgia | $216.06 | $123.70 |
| Hawaii, Guam, HIHawaii | $251.98 | $134.25 |
| IowaIowa | $214.01 | $119.27 |
| IdahoIdaho | $215.40 | $120.14 |
| East St. Louis, ILIllinois | $226.72 | $131.46 |
| Rest of IllinoisIllinois | $222.25 | $127.72 |
| Suburban Chicago, ILIllinois | $243.02 | $136.68 |
| IndianaIndiana | $216.65 | $120.66 |
| KansasKansas | $212.99 | $119.38 |
| KentuckyKentucky | $213.53 | $121.48 |
| New Orleans, LALouisiana | $223.73 | $126.30 |
| Rest of LouisianaLouisiana | $213.19 | $121.55 |
| Metropolitan Boston, MAMassachusetts | $266.14 | $142.51 |
| Rest of MassachusettsMassachusetts | $240.69 | $131.65 |
| Baltimore area, MDMaryland | $247.22 | $136.12 |
| Rest of MarylandMaryland | $234.45 | $129.66 |
| Rest of MaineMaine | $216.49 | $121.23 |
| Southern Maine, MEMaine | $228.27 | $125.66 |
| Detroit, MIMichigan | $231.74 | $131.82 |
| Rest of MichiganMichigan | $219.06 | $124.53 |
| MinnesotaMinnesota | $232.08 | $125.54 |
| Metropolitan Kansas City, MOMissouri | $222.24 | $125.01 |
| Metropolitan St. Louis, MOMissouri | $224.56 | $125.99 |
| Rest of MissouriMissouri | $209.51 | $120.26 |
| MississippiMississippi | $207.62 | $118.47 |
| MontanaMontana | $232.46 | $128.91 |
| North CarolinaNorth Carolina | $218.76 | $122.16 |
| North DakotaNorth Dakota | $228.11 | $124.56 |
| NebraskaNebraska | $215.19 | $119.62 |
| New HampshireNew Hampshire | $238.32 | $130.53 |
| Northern New JerseyNew Jersey | $263.16 | $143.05 |
| Rest of New JerseyNew Jersey | $250.77 | $137.70 |
| New MexicoNew Mexico | $220.25 | $125.30 |
| NevadaNevada | $231.41 | $127.76 |
| NYC suburbs and Long Island, NYNew York | $273.80 | $150.69 |
| Poughkeepsie and northern NYC suburbs, NYNew York | $252.39 | $139.01 |
| Queens, NYNew York | $269.60 | $147.21 |
| Rest of New YorkNew York | $222.04 | $123.67 |
| OhioOhio | $218.17 | $123.64 |
| OklahomaOklahoma | $213.18 | $120.71 |
| Portland, OROregon | $249.87 | $134.83 |
| Rest of OregonOregon | $229.63 | $126.50 |
| Metropolitan Philadelphia, PAPennsylvania | $241.74 | $133.95 |
| Rest of PennsylvaniaPennsylvania | $218.54 | $123.48 |
| Puerto RicoPuerto Rico | $234.18 | $129.49 |
| Rhode IslandRhode Island | $238.26 | $131.30 |
| South CarolinaSouth Carolina | $218.83 | $123.15 |
| South DakotaSouth Dakota | $227.59 | $124.05 |
| TennesseeTennessee | $214.05 | $119.93 |
| Austin, TXTexas | $241.32 | $131.77 |
| Beaumont, TXTexas | $217.10 | $122.87 |
| Brazoria, TXTexas | $229.85 | $127.24 |
| Dallas, TXTexas | $231.31 | $128.18 |
| Fort Worth, TXTexas | $229.75 | $127.66 |
| Galveston, TXTexas | $230.53 | $127.71 |
| Houston, TXTexas | $234.56 | $131.74 |
| Rest of TexasTexas | $223.34 | $125.08 |
| UtahUtah | $221.82 | $124.49 |
| VirginiaVirginia | $227.50 | $125.72 |
| Virgin Islands, VIUnited States Virgin Islands | $234.18 | $129.49 |
| VermontVermont | $227.19 | $124.68 |
| Rest of WashingtonWashington | $240.24 | $131.21 |
| King County, WAWashington | $271.59 | $144.54 |
| WisconsinWisconsin | $220.46 | $121.26 |
| West VirginiaWest Virginia | $214.02 | $124.04 |
| WyomingWyoming | $230.56 | $127.02 |
42160 rates by state
Office rate range in each state. Select a state to see its payment localities.
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.
$205.64
$277.26
Color shows the midpoint of each state’s locality range.
View every state and territory as a table
| State / territory | Office rate range | Localities |
|---|---|---|
| AK | $269.96 | 1 |
| AL | $208.66 | 1 |
| AR | $205.64 | 1 |
| AZ | $226.30 | 1 |
| CA | $245.92–$308.60 | 29 |
| CO | $242.14 | 1 |
| CT | $247.92 | 1 |
| DC | $265.92 | 1 |
| DE | $230.05 | 1 |
| FL | $228.91–$250.47 | 3 |
| GA | $216.06–$236.77 | 2 |
| GU | $251.98 | 1 |
| HI | $251.98 | 1 |
| IA | $214.01 | 1 |
| ID | $215.40 | 1 |
| IL | $222.25–$243.23 | 4 |
| IN | $216.65 | 1 |
| KS | $212.99 | 1 |
| KY | $213.53 | 1 |
| LA | $213.19–$223.73 | 2 |
| MA | $240.69–$266.14 | 2 |
| MD | $234.45–$265.92 | 3 |
| ME | $216.49–$228.27 | 2 |
| MI | $219.06–$231.74 | 2 |
| MN | $232.08 | 1 |
| MO | $209.51–$224.56 | 3 |
| MS | $207.62 | 1 |
| MT | $232.46 | 1 |
| NC | $218.76 | 1 |
| ND | $228.11 | 1 |
| NE | $215.19 | 1 |
| NH | $238.32 | 1 |
| NJ | $250.77–$263.16 | 2 |
| NM | $220.25 | 1 |
| NV | $231.41 | 1 |
| NY | $222.04–$273.80 | 5 |
| OH | $218.17 | 1 |
| OK | $213.18 | 1 |
| OR | $229.63–$249.87 | 2 |
| PA | $218.54–$241.74 | 2 |
| PR | $234.18 | 1 |
| RI | $238.26 | 1 |
| SC | $218.83 | 1 |
| SD | $227.59 | 1 |
| TN | $214.05 | 1 |
| TX | $217.10–$241.32 | 8 |
| UT | $221.82 | 1 |
| VA | $227.50–$265.92 | 2 |
| VI | $234.18 | 1 |
| VT | $227.19 | 1 |
| WA | $240.24–$271.59 | 2 |
| WI | $220.46 | 1 |
| WV | $214.02 | 1 |
| WY | $230.56 | 1 |
How the 42160 rate is calculated
Each of 42160’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 · 42160
RVUs × geographic indexes × conversion factor
Work1.80
1.80 RVUs× 1.000 GPCI
Practice expense4.94
4.94 RVUs× 1.000 GPCI
Malpractice0.22
0.22 RVUs× 1.000 GPCI
Adjusted RVUs
6.9600
Conversion factor
$33.4009
Medicare rate
$232.47
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
The exact Merced, CA inputs and CMS source lines
PPRRVU2026_Oct_nonQPP.csv
5,001
- Code
- 42160
- Physician work
- 1.80
- Practice expense
- 4.94
- Malpractice
- 0.22
GPCI2026.csv
15
- Locality
- Merced, CA
- Physician work
- 1.017
- Practice expense
- 1.096
- Malpractice
- 0.536
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 1.80 | × 1.017 | 1.8306 |
| Practice expense | 4.94 | × 1.096 | 5.4142 |
| Malpractice | 0.22 | × 0.536 | 0.1179 |
| Total RVUs | 7.3628 | ||
| Conversion factor | × 33.4009 | ||
Office rate, Merced, CA$245.92
Office: (1.8 × 1.017 + 4.94 × 1.096 + 0.22 × 0.536) × $33.4009 = $245.92
Facility: (1.8 × 1.017 + 1.84 × 1.096 + 0.22 × 0.536) × $33.4009 = $132.44
Payment rules and modifiers for 42160
42160 has a 10-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 42160
Palate lesion treatment, destruction method
| 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) | 0 | Not paid without supporting documentation. |
| 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 · 42160
Palate lesion treatment, destruction method
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
42160 without 51 · national office
$232.47
Palate lesion treatment, destruction method
42160-51 · Second procedure: 50%
$116.24
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%).
How 42160 has changed in Merced, CA
42160 · Office / nonfacility
$245.92
Effective 2026-10-01
The base rate is $17.21 higher than on 2025-10-01, moving from $228.71 to $245.92 (7.5%).
It is unchanged from the immediately preceding available release, effective 2026-07-01.
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
January 1, 2026
RVU26A
$228.71changed to$245.92
- Conversion factor 32.3465 changed to 33.4009
- Work RVU 1.85 changed to 1.80
- Practice expense RVU 4.64 changed to 4.94
- Work GPCI 1.014 changed to 1.017
- Practice expense GPCI 1.093 changed to 1.096
- Malpractice GPCI 0.560 changed to 0.536
Held through RVU26B, RVU26C, RVU26D.
January 1, 2025
RVU25A
$239.01changed to$228.71
- Conversion factor 33.2875 changed to 32.3465
- Practice expense RVU 4.73 changed to 4.64
- Malpractice RVU 0.24 changed to 0.22
Held through RVU25B, RVU25C, RVU25D.
March 9, 2024
RVU24AR
$235.11changed to$239.01
- Conversion factor 32.7442 changed to 33.2875
Held through RVU24B, RVU24C, RVU24D.
January 1, 2024
RVU24A
$248.44changed to$235.11
- Conversion factor 33.8872 changed to 32.7442
- Practice expense RVU 4.91 changed to 4.73
- Malpractice RVU 0.25 changed to 0.24
- Work GPCI 1.021 changed to 1.014
- Practice expense GPCI 1.079 changed to 1.093
- Malpractice GPCI 0.579 changed to 0.560
January 1, 2023
RVU23A
$251.30changed to$248.44
- Conversion factor 34.6062 changed to 33.8872
- Practice expense RVU 4.90 changed to 4.91
- Malpractice RVU 0.24 changed to 0.25
- Work GPCI 1.027 changed to 1.021
- Practice expense GPCI 1.065 changed to 1.079
- Malpractice GPCI 0.597 changed to 0.579
Held through RVU23B, RVU23C, RVU23D.
January 1, 2022
RVU22A
$253.59changed to$251.30
- Conversion factor 34.8931 changed to 34.6062
- Malpractice RVU 0.25 changed to 0.24
Held through RVU22B, RVU22C, RVU22D.
January 1, 2021
RVU21A
$251.80changed to$253.59
- Conversion factor 36.0896 changed to 34.8931
- Practice expense RVU 4.62 changed to 4.90
- Malpractice RVU 0.24 changed to 0.25
- Work GPCI 1.024 changed to 1.027
- Practice expense GPCI 1.070 changed to 1.065
- Malpractice GPCI 0.580 changed to 0.597
Held through RVU21B, RVU21C, RVU21D.
January 1, 2020
RVU20A
$250.36changed to$251.80
- Conversion factor 36.0391 changed to 36.0896
- Practice expense RVU 4.57 changed to 4.62
- Malpractice RVU 0.27 changed to 0.24
- Work GPCI 1.020 changed to 1.024
- Practice expense GPCI 1.074 changed to 1.070
- Malpractice GPCI 0.562 changed to 0.580
Held through RVU20B, RVU20C, RVU20D.
January 1, 2019
RVU19A
$247.18changed to$250.36
- Conversion factor 35.9996 changed to 36.0391
- Practice expense RVU 4.50 changed to 4.57
- Malpractice RVU 0.26 changed to 0.27
Held through RVU19B, RVU19C, RVU19D.
January 1, 2018
RVU18AR1
$251.09changed to$247.18
- Conversion factor 35.8887 changed to 35.9996
- Practice expense RVU 4.57 changed to 4.50
- Malpractice RVU 0.28 changed to 0.26
- Work GPCI 1.024 changed to 1.020
- Practice expense GPCI 1.079 changed to 1.074
- Malpractice GPCI 0.610 changed to 0.562
Held through RVU18B, RVU18C, RVU18D.
January 1, 2017
RVU17A
No ratechanged to$251.09
Held through RVU17B, RVU17C, RVU17D.
January 1, 2013
RVU13AR
Earliest loaded release: No rate
Held through RVU13B, RVU13C, RVU13D, RVU14A, RVU14B, RVU14C, RVU14D, RVU15A, RVU15B, RVU15C, RVU15D, RVU16A, RVU16B, RVU16C, RVU16D.
| Effective from | Office | Facility | CMS release |
|---|---|---|---|
| 2026-10-01 | $245.92 | $132.44 | RVU26D |
| 2026-07-01 | $245.92 | $132.44 | RVU26C |
| 2026-04-01 | $245.92 | $132.44 | RVU26B |
| 2026-01-01 | $245.92 | $132.44 | RVU26A |
| 2025-10-01 | $228.71 | $141.38 | RVU25D |
| 2025-07-01 | $228.71 | $141.38 | RVU25C |
| 2025-04-01 | $228.71 | $141.38 | RVU25B |
| 2025-01-01 | $228.71 | $141.38 | RVU25A |
| 2024-10-01 | $239.01 | $145.51 | RVU24D |
| 2024-07-01 | $239.01 | $145.51 | RVU24C |
| 2024-04-01 | $239.01 | $145.51 | RVU24B |
| 2024-03-09 | $239.01 | $145.51 | RVU24AR |
| 2024-01-01 | $235.11 | $143.13 | RVU24A |
| 2023-10-01 | $248.44 | $149.35 | RVU23D |
| 2023-07-01 | $248.44 | $149.35 | RVU23C |
| 2023-04-01 | $248.44 | $149.35 | RVU23B |
| 2023-01-01 | $248.44 | $149.35 | RVU23A |
| 2022-10-01 | $251.30 | $149.21 | RVU22D |
| 2022-07-01 | $251.30 | $149.21 | RVU22C |
| 2022-04-01 | $251.30 | $149.21 | RVU22B |
| 2022-01-01 | $251.30 | $149.21 | RVU22A |
| 2021-10-01 | $253.59 | $149.91 | RVU21D |
| 2021-07-01 | $253.59 | $149.91 | RVU21C |
| 2021-04-01 | $253.59 | $149.91 | RVU21B |
| 2021-01-01 | $253.59 | $149.91 | RVU21A |
| 2020-10-01 | $251.80 | $152.94 | RVU20D |
| 2020-07-01 | $251.80 | $152.94 | RVU20C |
| 2020-04-01 | $251.80 | $152.94 | RVU20B |
| 2020-01-01 | $251.80 | $152.94 | RVU20A |
| 2019-10-01 | $250.36 | $154.37 | RVU19D |
| 2019-07-01 | $250.36 | $154.37 | RVU19C |
| 2019-04-01 | $250.36 | $154.37 | RVU19B |
| 2019-01-01 | $250.36 | $154.37 | RVU19A |
| 2018-10-01 | $247.18 | $154.77 | RVU18D |
| 2018-07-01 | $247.18 | $154.77 | RVU18C |
| 2018-04-01 | $247.18 | $154.77 | RVU18B |
| 2018-01-01 | $247.18 | $154.77 | RVU18AR1 |
| 2017-10-01 | $251.09 | $156.99 | RVU17D |
| 2017-07-01 | $251.09 | $156.99 | RVU17C |
| 2017-04-01 | $251.09 | $156.99 | RVU17B |
| 2017-01-01 | $251.09 | $156.99 | RVU17A |
| 2016-10-01 | Rate data unavailable | Rate data unavailable | RVU16D |
| 2016-07-01 | Rate data unavailable | Rate data unavailable | RVU16C |
| 2016-04-01 | Rate data unavailable | Rate data unavailable | RVU16B |
| 2016-01-01 | Rate data unavailable | Rate data unavailable | RVU16A |
| 2015-10-01 | Rate data unavailable | Rate data unavailable | RVU15D |
| 2015-07-01 | Rate data unavailable | Rate data unavailable | RVU15C |
| 2015-04-01 | Rate data unavailable | Rate data unavailable | RVU15B |
| 2015-01-01 | Rate data unavailable | Rate data unavailable | RVU15A |
| 2014-10-01 | Rate data unavailable | Rate data unavailable | RVU14D |
| 2014-07-01 | Rate data unavailable | Rate data unavailable | RVU14C |
| 2014-04-01 | Rate data unavailable | Rate data unavailable | RVU14B |
| 2014-01-01 | Rate data unavailable | Rate data unavailable | RVU14A |
| 2013-10-01 | Rate data unavailable | Rate data unavailable | RVU13D |
| 2013-07-01 | Rate data unavailable | Rate data unavailable | RVU13C |
| 2013-04-01 | Rate data unavailable | Rate data unavailable | RVU13B |
| 2013-01-01 | Rate data unavailable | Rate data unavailable | RVU13AR |
Where the Merced, CA rate applies
Merced, CA is a Medicare payment area, not a city. Our Census mapping connects it to 24 cities and communities in California. Some span more than one payment area; confirm with the service ZIP.
- Merced
- Atwater
- Ballico
- Bear Creek
- Cressey
- Delhi
- Dos Palos
- Dos Palos Y
42160 billing questions
When should this code be chosen over a palate biopsy code?
Use this code when the lesion is destroyed, for example with laser or cautery. A biopsy code describes tissue sampling for examination.
How does this differ from palate lesion excision?
This code represents destruction of the lesion. Choose an excision code when the service removes the lesion surgically rather than destroying it.
Are related postoperative visits separately reported?
Related postoperative visits during the 10-day global period are included in this procedure’s payment.
How are other procedures performed in the same session paid?
The highest-valued procedure is paid in full; other procedures in the session are subject to the standard multiple-procedure reduction.
Can modifier 50 or an assistant-at-surgery claim be used?
Modifier 50 is inappropriate for this service. Assistant-at-surgery payment requires documentation of medical necessity.
Can co-surgeons or a surgical team report this service?
Co-surgeons and team surgery are not permitted for this code.
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
Fee sheets · Coming soon
Put 42160 and the rest of your codes on one sheet
Your codes at your locality, with payer contracts beside Medicare.
Join the waitlist