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CPT code 42160: Palate lesion treatment, destruction method2026 Medicare rate & RVUs in Puerto Rico

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 Puerto Rico, Medicare pays $234.18 for 42160 in the office and $129.49 when it’s performed in a hospital or facility.

$234.18Office (non-facility)
$129.49Hospital or facility
+0.7%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 Puerto Rico
  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 Puerto Rico 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. Puerto Rico pays $234.18. The RVUs are the same everywhere; the geographic indexes change the dollars.

42160 in Puerto Rico vs other payment areas
  1. Puerto Rico · this page$234.18
  2. Los Angeles, CA · California$262.66+$28.48
  3. Washington, DC area · District of Columbia$265.92+$31.74
  4. Miami, FL · Florida$250.47+$16.29
  5. Chicago, IL · Illinois$243.23+$9.05
  6. Manhattan, NY · New York$267.35+$33.17
  7. Alaska · Alaska$269.96+$35.78

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

Every other payment area

42160 in every other Medicare payment locality
Payment localityOfficeFacility
AlabamaAlabama$208.66$118.06
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

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 Puerto Rico 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

91

Locality
Puerto Rico
Physician work
1.000
Practice expense
1.011
Malpractice
0.985
Office calculation for 42160 in Puerto Rico
ComponentRVULocality factorAdjusted
Physician work1.80× 1.0001.8000
Practice expense4.94× 1.0114.9943
Malpractice0.22× 0.9850.2167
Total RVUs7.0110
Conversion factor× 33.4009

Office rate, Puerto Rico$234.18

Office: (1.8 × 1 + 4.94 × 1.011 + 0.22 × 0.985) × $33.4009 = $234.18

Facility: (1.8 × 1 + 1.84 × 1.011 + 0.22 × 0.985) × $33.4009 = $129.49

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, Puerto Rico
Used instead
42100Palate biopsy, tissue samplingBiopsy samples a palate lesion for examination rather than destroying it.$150.97
42104Palatal excision, without closureUsed for surgical excision of a palate lesion instead of destruction.$220.05
42106Palate excision, simple primary closureAn excision option for a palate lesion when tissue is removed rather than destroyed.$263.40

How 42160 has changed in Puerto Rico

42160 · Office / nonfacility

$234.18

Effective 2026-10-01

The base rate is $16.21 higher than on 2025-10-01, moving from $217.97 to $234.18 (7.4%).

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

    $217.97changed to$234.18

    • 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
    • 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

    $227.98changed to$217.97

    • 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

    $224.26changed to$227.98

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $238.74changed to$224.26

    • 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
    • Practice expense GPCI 1.008 changed to 1.007
    • Malpractice GPCI 0.984 changed to 0.982

  5. October 1, 2023

    RVU23D

    $237.55changed to$238.74

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

  6. January 1, 2023

    RVU23A

    $243.14changed to$237.55

    • 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
    • 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

    $245.50changed to$243.14

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

    Held through RVU22B, RVU22C, RVU22D.

  8. January 1, 2021

    RVU21A

    $243.39changed to$245.50

    • 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
    • Malpractice GPCI 0.988 changed to 0.986

    Held through RVU21B, RVU21C, RVU21D.

  9. January 1, 2020

    RVU20A

    $242.16changed to$243.39

    • 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
    • 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

    $239.00changed to$242.16

    • 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.

  11. January 1, 2018

    RVU18AR1

    $213.24changed to$239.00

    • 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
    • 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

    $186.30changed to$213.24

    • Conversion factor 35.8043 changed to 35.8887
    • Practice expense RVU 4.64 changed to 4.57
    • 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

    $186.46changed to$186.30

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

    Held through RVU16B, RVU16C, RVU16D.

  14. July 1, 2015

    RVU15C

    $185.54changed to$186.46

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  15. January 1, 2015

    RVU15A

    $184.02changed to$185.54

    • 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
    • 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

    $183.31changed to$184.02

    • 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
    • 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: $183.31

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$234.18$129.49RVU26D
2026-07-01$234.18$129.49RVU26C
2026-04-01$234.18$129.49RVU26B
2026-01-01$234.18$129.49RVU26A
2025-10-01$217.97$137.51RVU25D
2025-07-01$217.97$137.51RVU25C
2025-04-01$217.97$137.51RVU25B
2025-01-01$217.97$137.51RVU25A
2024-10-01$227.98$141.83RVU24D
2024-07-01$227.98$141.83RVU24C
2024-04-01$227.98$141.83RVU24B
2024-03-09$227.98$141.83RVU24AR
2024-01-01$224.26$139.52RVU24A
2023-10-01$238.74$146.18RVU23D
2023-07-01$237.55$145.71RVU23C
2023-04-01$237.55$145.71RVU23B
2023-01-01$237.55$145.71RVU23A
2022-10-01$243.14$146.51RVU22D
2022-07-01$243.14$146.51RVU22C
2022-04-01$243.14$146.51RVU22B
2022-01-01$243.14$146.51RVU22A
2021-10-01$245.50$147.37RVU21D
2021-07-01$245.50$147.37RVU21C
2021-04-01$245.50$147.37RVU21B
2021-01-01$245.50$147.37RVU21A
2020-10-01$243.39$150.26RVU20D
2020-07-01$243.39$150.26RVU20C
2020-04-01$243.39$150.26RVU20B
2020-01-01$243.39$150.26RVU20A
2019-10-01$242.16$152.15RVU19D
2019-07-01$242.16$152.15RVU19C
2019-04-01$242.16$152.15RVU19B
2019-01-01$242.16$152.15RVU19A
2018-10-01$239.00$152.36RVU18D
2018-07-01$239.00$152.36RVU18C
2018-04-01$239.00$152.36RVU18B
2018-01-01$239.00$152.36RVU18AR1
2017-10-01$213.24$138.59RVU17D
2017-07-01$213.24$138.59RVU17C
2017-04-01$213.24$138.59RVU17B
2017-01-01$213.24$138.59RVU17A
2016-10-01$186.30$124.20RVU16D
2016-07-01$186.30$124.20RVU16C
2016-04-01$186.30$124.20RVU16B
2016-01-01$186.30$124.20RVU16A
2015-10-01$186.46$124.65RVU15D
2015-07-01$186.46$124.65RVU15C
2015-04-01$185.54$124.03RVU15B
2015-01-01$185.54$124.03RVU15A
2014-10-01$184.02$123.04RVU14D
2014-07-01$184.02$123.04RVU14C
2014-04-01$184.02$123.04RVU14B
2014-01-01$184.02$123.04RVU14A
2013-10-01$183.31$120.57RVU13D
2013-07-01$183.31$120.57RVU13C
2013-04-01$183.31$120.57RVU13B
2013-01-01$183.31$120.57RVU13AR

Price 42160 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

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 Puerto RicoGPCI2026.csv, line 91 (RVU26D)

Open CMS sourceHow we calculate rates

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