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CPT code 42160: Palate lesion treatment, destruction method2026 Medicare rate & RVUs in Washington, DC area

Reports destruction of a lesion on the palate or uvula, such as treatment using laser or cautery rather than biopsy or excision.

CMS RVU26DEffective Oct 1, 2026One payment locality99 Medicare services in 2024

In Washington, DC area, Medicare pays $265.92 for 42160 in the office and $143.94 when it’s performed in a hospital or facility.

$265.92Office (non-facility)
$143.94Hospital or facility
+14.4%vs the national office rate ($232.47)

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.

We’ll open 42160 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in Washington, DC area
  2. What 42160 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 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 Washington, DC area 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. Washington, DC area pays $265.92. The RVUs are the same everywhere; the geographic indexes change the dollars.

42160 in Washington, DC area vs other payment areas
  1. Washington, DC area · this page$265.92
  2. Los Angeles, CA · California$262.66−$3.26
  3. Miami, FL · Florida$250.47−$15.45
  4. Chicago, IL · Illinois$243.23−$22.69
  5. Manhattan, NY · New York$267.35+$1.43
  6. Alaska · Alaska$269.96+$4.04
  7. Alabama · Alabama$208.66−$57.26

Other areas in District of Columbia first, then benchmark localities. Bars start at $0.

Every other payment area

42160 in every other Medicare payment locality
Payment localityOfficeFacility
ArkansasArkansas$205.64$116.70
ArizonaArizona$226.30$125.96
Bakersfield, CACalifornia$246.58$133.10
Chico, CACalifornia$245.92$132.44
El Centro, CACalifornia$245.96$132.48
Fresno, CACalifornia$245.92$132.44
Hanford, CACalifornia$245.92$132.44
Madera, CACalifornia$245.92$132.44

42160 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.

$205.64

$277.26

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

View every state and territory as a table
42160 office rate range by state
State / territoryOffice rate rangeLocalities
AK$269.961
AL$208.661
AR$205.641
AZ$226.301
CA$245.92–$308.6029
CO$242.141
CT$247.921
DC$265.921
DE$230.051
FL$228.91–$250.473
GA$216.06–$236.772
GU$251.981
HI$251.981
IA$214.011
ID$215.401
IL$222.25–$243.234
IN$216.651
KS$212.991
KY$213.531
LA$213.19–$223.732
MA$240.69–$266.142
MD$234.45–$265.923
ME$216.49–$228.272
MI$219.06–$231.742
MN$232.081
MO$209.51–$224.563
MS$207.621
MT$232.461
NC$218.761
ND$228.111
NE$215.191
NH$238.321
NJ$250.77–$263.162
NM$220.251
NV$231.411
NY$222.04–$273.805
OH$218.171
OK$213.181
OR$229.63–$249.872
PA$218.54–$241.742
PR$234.181
RI$238.261
SC$218.831
SD$227.591
TN$214.051
TX$217.10–$241.328
UT$221.821
VA$227.50–$265.922
VI$234.181
VT$227.191
WA$240.24–$271.592
WI$220.461
WV$214.021
WY$230.561

See 42160 in every payment locality

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

Office or facility?

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 Washington, DC area 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

39

Locality
Washington, DC area
Physician work
1.054
Practice expense
1.178
Malpractice
1.113
Office calculation for 42160 in Washington, DC area
ComponentRVULocality factorAdjusted
Physician work1.80× 1.0541.8972
Practice expense4.94× 1.1785.8193
Malpractice0.22× 1.1130.2449
Total RVUs7.9614
Conversion factor× 33.4009

Office rate, Washington, DC area$265.92

Office: (1.8 × 1.054 + 4.94 × 1.178 + 0.22 × 1.113) × $33.4009 = $265.92

Facility: (1.8 × 1.054 + 1.84 × 1.178 + 0.22 × 1.113) × $33.4009 = $143.94

Open 42160 in the RVU calculator

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

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)0Not paid without supporting documentation.
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 · 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.

SurgeryVisit
Sep 28, 2026Oct 14, 2026

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%).

When to use modifier 51

Codes related to 42160

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

Codes related to 42160
CodeHow it relatesOffice range, Washington, DC area
Used instead
42100Palate biopsy, tissue samplingBiopsy samples a palate lesion for examination rather than destroying it.$170.77
42104Palatal excision, without closureUsed for surgical excision of a palate lesion instead of destruction.$250.01
42106Palate excision, simple primary closureAn excision option for a palate lesion when tissue is removed rather than destroyed.$298.80

How 42160 has changed in Washington, DC area

42160 · Office / nonfacility

$265.92

Effective 2026-10-01

The base rate is $15.45 higher than on 2025-10-01, moving from $250.47 to $265.92 (6.2%).

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

    $250.47changed to$265.92

    • 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 1.057 changed to 1.054
    • Practice expense GPCI 1.192 changed to 1.178
    • Malpractice GPCI 1.168 changed to 1.113

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $262.10changed to$250.47

    • 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.

  3. March 9, 2024

    RVU24AR

    $257.83changed to$262.10

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $278.62changed to$257.83

    • 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 1.056 changed to 1.057
    • Practice expense GPCI 1.214 changed to 1.192
    • Malpractice GPCI 1.231 changed to 1.168

  5. January 1, 2023

    RVU23A

    $287.81changed to$278.62

    • 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 1.054 changed to 1.056
    • Practice expense GPCI 1.236 changed to 1.214
    • Malpractice GPCI 1.294 changed to 1.231

    Held through RVU23B, RVU23C, RVU23D.

  6. January 1, 2022

    RVU22A

    $290.65changed to$287.81

    • Conversion factor 34.8931 changed to 34.6062
    • Malpractice RVU 0.25 changed to 0.24

    Held through RVU22B, RVU22C, RVU22D.

  7. January 1, 2021

    RVU21A

    $284.68changed to$290.65

    • 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 1.049 changed to 1.054
    • Practice expense GPCI 1.221 changed to 1.236
    • Malpractice GPCI 1.277 changed to 1.294

    Held through RVU21B, RVU21C, RVU21D.

  8. January 1, 2020

    RVU20A

    $280.40changed to$284.68

    • 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 1.045 changed to 1.049
    • Practice expense GPCI 1.205 changed to 1.221
    • Malpractice GPCI 1.261 changed to 1.277

    Held through RVU20B, RVU20C, RVU20D.

  9. January 1, 2019

    RVU19A

    $276.61changed to$280.40

    • 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.

  10. January 1, 2018

    RVU18AR1

    $279.99changed to$276.61

    • 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 1.048 changed to 1.045
    • Malpractice GPCI 1.271 changed to 1.261

    Held through RVU18B, RVU18C, RVU18D.

  11. January 1, 2017

    RVU17A

    $282.64changed to$279.99

    • Conversion factor 35.8043 changed to 35.8887
    • Practice expense RVU 4.64 changed to 4.57
    • Work GPCI 1.051 changed to 1.048
    • Malpractice GPCI 1.280 changed to 1.271

    Held through RVU17B, RVU17C, RVU17D.

  12. January 1, 2016

    RVU16A

    $282.79changed to$282.64

    • Conversion factor 35.9335 changed to 35.8043
    • Practice expense RVU 4.62 changed to 4.64

    Held through RVU16B, RVU16C, RVU16D.

  13. July 1, 2015

    RVU15C

    $281.38changed to$282.79

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  14. January 1, 2015

    RVU15A

    $280.17changed to$281.38

    • Conversion factor 35.8228 changed to 35.7547
    • Practice expense RVU 4.66 changed to 4.62
    • Malpractice RVU 0.23 changed to 0.28
    • Work GPCI 1.050 changed to 1.051
    • Practice expense GPCI 1.202 changed to 1.205
    • Malpractice GPCI 1.205 changed to 1.280

    Held through RVU15B.

  15. January 1, 2014

    RVU14A

    $284.35changed to$280.17

    • Conversion factor 34.0230 changed to 35.8228
    • Practice expense RVU 5.13 changed to 4.66
    • Malpractice RVU 0.24 changed to 0.23
    • Work GPCI 1.049 changed to 1.050
    • Practice expense GPCI 1.198 changed to 1.202
    • Malpractice GPCI 1.130 changed to 1.205

    Held through RVU14B, RVU14C, RVU14D.

  16. January 1, 2013

    RVU13AR

    Earliest loaded release: $284.35

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$265.92$143.94RVU26D
2026-07-01$265.92$143.94RVU26C
2026-04-01$265.92$143.94RVU26B
2026-01-01$265.92$143.94RVU26A
2025-10-01$250.47$155.23RVU25D
2025-07-01$250.47$155.23RVU25C
2025-04-01$250.47$155.23RVU25B
2025-01-01$250.47$155.23RVU25A
2024-10-01$262.10$160.13RVU24D
2024-07-01$262.10$160.13RVU24C
2024-04-01$262.10$160.13RVU24B
2024-03-09$262.10$160.13RVU24AR
2024-01-01$257.83$157.52RVU24A
2023-10-01$278.62$167.14RVU23D
2023-07-01$278.62$167.14RVU23C
2023-04-01$278.62$167.14RVU23B
2023-01-01$278.62$167.14RVU23A
2022-10-01$287.81$169.33RVU22D
2022-07-01$287.81$169.33RVU22C
2022-04-01$287.81$169.33RVU22B
2022-01-01$287.81$169.33RVU22A
2021-10-01$290.65$170.33RVU21D
2021-07-01$290.65$170.33RVU21C
2021-04-01$290.65$170.33RVU21B
2021-01-01$290.65$170.33RVU21A
2020-10-01$284.68$171.87RVU20D
2020-07-01$284.68$171.87RVU20C
2020-04-01$284.68$171.87RVU20B
2020-01-01$284.68$171.87RVU20A
2019-10-01$280.40$172.71RVU19D
2019-07-01$280.40$172.71RVU19C
2019-04-01$280.40$172.71RVU19B
2019-01-01$280.40$172.71RVU19A
2018-10-01$276.61$172.93RVU18D
2018-07-01$276.61$172.93RVU18C
2018-04-01$276.61$172.93RVU18B
2018-01-01$276.61$172.93RVU18AR1
2017-10-01$279.99$174.90RVU17D
2017-07-01$279.99$174.90RVU17C
2017-04-01$279.99$174.90RVU17B
2017-01-01$279.99$174.90RVU17A
2016-10-01$282.64$176.50RVU16D
2016-07-01$282.64$176.50RVU16C
2016-04-01$282.64$176.50RVU16B
2016-01-01$282.64$176.50RVU16A
2015-10-01$282.79$177.14RVU15D
2015-07-01$282.79$177.14RVU15C
2015-04-01$281.38$176.26RVU15B
2015-01-01$281.38$176.26RVU15A
2014-10-01$280.17$174.24RVU14D
2014-07-01$280.17$174.24RVU14C
2014-04-01$280.17$174.24RVU14B
2014-01-01$280.17$174.24RVU14A
2013-10-01$284.35$173.48RVU13D
2013-07-01$284.35$173.48RVU13C
2013-04-01$284.35$173.48RVU13B
2013-01-01$284.35$173.48RVU13AR

Price 42160 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

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
RVUs for 42160PPRRVU2026_Oct_nonQPP.csv, line 5,001 (RVU26D)
Geographic factors for Washington, DC areaGPCI2026.csv, line 39 (RVU26D)

Open CMS sourceHow we calculate rates

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