CPT code 42180: Palate repair, laceration under 2 cm2026 Medicare rate & RVUs in Delaware
Repair a palatal laceration measuring less than 2 cm, typically after oral trauma, when the clinician closes the wound rather than excising a lesion.
In Delaware, Medicare pays $252.13 for 42180 in the office and $166.99 when it’s performed in a hospital or facility.
Check a contract rate as a % of Medicare · 42180 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 42180 covers
This service covers closure of a short laceration of the palate, such as an acute traumatic wound involving palatal tissue. An otolaryngologist, oral and maxillofacial surgeon, or other qualified clinician may perform the repair in an operating room or another setting equipped for the procedure. The operative record should identify the injured palatal site, document a wound length under 2 cm, and describe the repair performed.
Report the code for the laceration repair itself, not for a biopsy or removal of a palatal lesion. The code has a 10-day global period, which includes related postoperative visits during that period. 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 multiple procedure reduction. Modifier 50 is inappropriate for this repair. 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 Delaware compares for 42180
Across 109 of 109 payment localities, the office rate for 42180 runs from $226.51 in Arkansas to $328.99 in San Benito County, CA. Delaware pays $252.13. The RVUs are the same everywhere; the geographic indexes change the dollars.
- Delaware · this page$252.13
- Los Angeles, CA · California$283.44+$31.31
- Washington, DC area · District of Columbia$289.12+$36.99
- Miami, FL · Florida$279.78+$27.65
- Chicago, IL · Illinois$271.80+$19.67
- Manhattan, NY · New York$293.08+$40.95
- Alaska · Alaska$301.41+$49.28
Other areas in Delaware first, then benchmark localities. Bars start at $0.
Every other payment area
| Payment locality | Office | Facility |
|---|---|---|
| AlabamaAlabama | $229.67 | $154.27 |
| ArkansasArkansas | $226.51 | $152.48 |
| ArizonaArizona | $248.17 | $164.67 |
| Bakersfield, CACalifornia | $267.05 | $172.61 |
| Chico, CACalifornia | $266.01 | $171.56 |
| El Centro, CACalifornia | $266.07 | $171.62 |
| Fresno, CACalifornia | $266.01 | $171.56 |
| Hanford, CACalifornia | $266.01 | $171.56 |
| Madera, CACalifornia | $266.01 | $171.56 |
| Merced, CACalifornia | $266.01 | $171.56 |
| Modesto, CACalifornia | $266.01 | $171.56 |
| Napa, CACalifornia | $304.94 | $191.37 |
| Oxnard, CACalifornia | $281.70 | $179.84 |
| Redding, CACalifornia | $266.01 | $171.56 |
| Rest of CaliforniaCalifornia | $266.01 | $171.56 |
| Riverside, CACalifornia | $269.91 | $175.46 |
| Sacramento, CACalifornia | $278.29 | $178.07 |
| Salinas, CACalifornia | $277.23 | $177.36 |
| San Diego, CACalifornia | $283.13 | $180.06 |
| Marin County, CACalifornia | $321.70 | $200.20 |
| San Francisco, CACalifornia | $321.29 | $199.79 |
| San Benito County, CACalifornia | $328.99 | $204.72 |
| Santa Clara County, CACalifornia | $327.31 | $203.05 |
| San Luis Obispo, CACalifornia | $272.88 | $174.72 |
| Santa Cruz, CACalifornia | $285.34 | $180.64 |
| Santa Maria, CACalifornia | $278.10 | $177.62 |
| Santa Rosa, CACalifornia | $288.17 | $182.34 |
| Stockton, CACalifornia | $266.01 | $171.56 |
| Vallejo, CACalifornia | $304.35 | $190.78 |
| Visalia, CACalifornia | $266.01 | $171.56 |
| Yuba City, CACalifornia | $266.01 | $171.56 |
| ColoradoColorado | $263.43 | $171.74 |
| ConnecticutConnecticut | $271.33 | $178.52 |
| Fort Lauderdale, FLFlorida | $266.64 | $179.35 |
| Rest of FloridaFlorida | $253.87 | $171.49 |
| Atlanta, GAGeorgia | $260.07 | $172.52 |
| Rest of GeorgiaGeorgia | $239.91 | $163.05 |
| Hawaii, Guam, HIHawaii | $271.66 | $173.68 |
| IowaIowa | $234.03 | $155.18 |
| IdahoIdaho | $235.74 | $156.46 |
| East St. Louis, ILIllinois | $254.27 | $174.99 |
| Rest of IllinoisIllinois | $247.73 | $169.05 |
| Suburban Chicago, ILIllinois | $269.02 | $180.52 |
| IndianaIndiana | $237.01 | $157.13 |
| KansasKansas | $233.56 | $155.66 |
| KentuckyKentucky | $236.10 | $159.50 |
| New Orleans, LALouisiana | $247.06 | $165.97 |
| Rest of LouisianaLouisiana | $235.98 | $159.72 |
| Metropolitan Boston, MAMassachusetts | $287.91 | $185.02 |
| Rest of MassachusettsMassachusetts | $262.20 | $171.46 |
| Baltimore area, MDMaryland | $270.68 | $178.22 |
| Rest of MarylandMaryland | $256.61 | $169.40 |
| Rest of MaineMaine | $237.53 | $158.25 |
| Southern Maine, MEMaine | $248.97 | $163.58 |
| Detroit, MIMichigan | $257.51 | $174.35 |
| Rest of MichiganMichigan | $242.51 | $163.83 |
| MinnesotaMinnesota | $251.01 | $162.34 |
| Metropolitan Kansas City, MOMissouri | $244.83 | $163.92 |
| Metropolitan St. Louis, MOMissouri | $247.21 | $165.17 |
| Rest of MissouriMissouri | $232.50 | $158.22 |
| MississippiMississippi | $229.52 | $155.32 |
| MontanaMontana | $254.82 | $168.65 |
| North CarolinaNorth Carolina | $239.81 | $159.41 |
| North DakotaNorth Dakota | $247.71 | $161.53 |
| NebraskaNebraska | $235.08 | $155.54 |
| New HampshireNew Hampshire | $259.89 | $170.18 |
| Northern New JerseyNew Jersey | $286.45 | $186.49 |
| Rest of New JerseyNew Jersey | $274.03 | $179.93 |
| New MexicoNew Mexico | $244.01 | $164.99 |
| NevadaNevada | $253.00 | $166.74 |
| NYC suburbs and Long Island, NYNew York | $300.65 | $198.19 |
| Poughkeepsie and northern NYC suburbs, NYNew York | $276.28 | $181.92 |
| Queens, NYNew York | $294.54 | $192.69 |
| Rest of New YorkNew York | $243.29 | $161.43 |
| OhioOhio | $241.05 | $162.38 |
| OklahomaOklahoma | $235.08 | $158.13 |
| Portland, OROregon | $270.82 | $175.08 |
| Rest of OregonOregon | $250.64 | $164.81 |
| Metropolitan Philadelphia, PAPennsylvania | $265.21 | $175.51 |
| Rest of PennsylvaniaPennsylvania | $241.10 | $161.99 |
| Puerto RicoPuerto Rico | $256.42 | $169.30 |
| Rhode IslandRhode Island | $260.40 | $171.38 |
| South CarolinaSouth Carolina | $240.91 | $161.29 |
| South DakotaSouth Dakota | $246.86 | $160.69 |
| TennesseeTennessee | $234.75 | $156.42 |
| Austin, TXTexas | $262.90 | $171.73 |
| Beaumont, TXTexas | $239.63 | $161.21 |
| Brazoria, TXTexas | $251.43 | $166.03 |
| Dallas, TXTexas | $253.25 | $167.42 |
| Fort Worth, TXTexas | $251.81 | $166.84 |
| Galveston, TXTexas | $252.33 | $166.76 |
| Houston, TXTexas | $258.92 | $173.35 |
| Rest of TexasTexas | $245.54 | $163.76 |
| UtahUtah | $244.04 | $163.04 |
| VirginiaVirginia | $248.60 | $163.89 |
| Virgin Islands, VIUnited States Virgin Islands | $256.42 | $169.30 |
| VermontVermont | $247.31 | $162.00 |
| Rest of WashingtonWashington | $261.52 | $170.78 |
| King County, WAWashington | $293.05 | $187.31 |
| WisconsinWisconsin | $239.82 | $157.27 |
| West VirginiaWest Virginia | $239.12 | $164.23 |
| WyomingWyoming | $251.72 | $165.55 |
42180 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.
$226.51
$301.41
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 | $301.41 | 1 |
| AL | $229.67 | 1 |
| AR | $226.51 | 1 |
| AZ | $248.17 | 1 |
| CA | $266.01–$328.99 | 29 |
| CO | $263.43 | 1 |
| CT | $271.33 | 1 |
| DC | $289.12 | 1 |
| DE | $252.13 | 1 |
| FL | $253.87–$279.78 | 3 |
| GA | $239.91–$260.07 | 2 |
| GU | $271.66 | 1 |
| HI | $271.66 | 1 |
| IA | $234.03 | 1 |
| ID | $235.74 | 1 |
| IL | $247.73–$271.80 | 4 |
| IN | $237.01 | 1 |
| KS | $233.56 | 1 |
| KY | $236.10 | 1 |
| LA | $235.98–$247.06 | 2 |
| MA | $262.20–$287.91 | 2 |
| MD | $256.61–$289.12 | 3 |
| ME | $237.53–$248.97 | 2 |
| MI | $242.51–$257.51 | 2 |
| MN | $251.01 | 1 |
| MO | $232.50–$247.21 | 3 |
| MS | $229.52 | 1 |
| MT | $254.82 | 1 |
| NC | $239.81 | 1 |
| ND | $247.71 | 1 |
| NE | $235.08 | 1 |
| NH | $259.89 | 1 |
| NJ | $274.03–$286.45 | 2 |
| NM | $244.01 | 1 |
| NV | $253.00 | 1 |
| NY | $243.29–$300.65 | 5 |
| OH | $241.05 | 1 |
| OK | $235.08 | 1 |
| OR | $250.64–$270.82 | 2 |
| PA | $241.10–$265.21 | 2 |
| PR | $256.42 | 1 |
| RI | $260.40 | 1 |
| SC | $240.91 | 1 |
| SD | $246.86 | 1 |
| TN | $234.75 | 1 |
| TX | $239.63–$262.90 | 8 |
| UT | $244.04 | 1 |
| VA | $248.60–$289.12 | 2 |
| VI | $256.42 | 1 |
| VT | $247.31 | 1 |
| WA | $261.52–$293.05 | 2 |
| WI | $239.82 | 1 |
| WV | $239.12 | 1 |
| WY | $251.72 | 1 |
How the 42180 rate is calculated
Each of 42180’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 · 42180
RVUs × geographic indexes × conversion factor
Work2.49
2.49 RVUs× 1.000 GPCI
Practice expense4.78
4.78 RVUs× 1.000 GPCI
Malpractice0.36
0.36 RVUs× 1.000 GPCI
Adjusted RVUs
7.6300
Conversion factor
$33.4009
Medicare rate
$254.85
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
The exact Delaware inputs and CMS source lines
PPRRVU2026_Oct_nonQPP.csv
5,002
- Code
- 42180
- Physician work
- 2.49
- Practice expense
- 4.78
- Malpractice
- 0.36
GPCI2026.csv
40
- Locality
- Delaware
- Physician work
- 1.005
- Practice expense
- 0.988
- Malpractice
- 0.899
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 2.49 | × 1.005 | 2.5025 |
| Practice expense | 4.78 | × 0.988 | 4.7226 |
| Malpractice | 0.36 | × 0.899 | 0.3236 |
| Total RVUs | 7.5487 | ||
| Conversion factor | × 33.4009 | ||
Office rate, Delaware$252.13
Office: (2.49 × 1.005 + 4.78 × 0.988 + 0.36 × 0.899) × $33.4009 = $252.13
Facility: (2.49 × 1.005 + 2.2 × 0.988 + 0.36 × 0.899) × $33.4009 = $166.99
Payment rules and modifiers for 42180
42180 has a 10-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 42180
Palate repair, laceration under 2 cm
| 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 · 42180
Palate repair, laceration under 2 cm
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
42180 without 51 · national office
$254.85
Palate repair, laceration under 2 cm
42180-51 · Second procedure: 50%
$127.43
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 42180 has changed in Delaware
42180 · Office / nonfacility
$252.13
Effective 2026-10-01
The base rate is $6.75 higher than on 2025-10-01, moving from $245.38 to $252.13 (2.8%).
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
$245.38changed to$252.13
- Conversion factor 32.3465 changed to 33.4009
- Work RVU 2.55 changed to 2.49
- Practice expense RVU 4.69 changed to 4.78
- Malpractice RVU 0.38 changed to 0.36
- Work GPCI 1.009 changed to 1.005
- Practice expense GPCI 0.992 changed to 0.988
- Malpractice GPCI 0.949 changed to 0.899
Held through RVU26B, RVU26C, RVU26D.
January 1, 2025
RVU25A
$255.18changed to$245.38
- Conversion factor 33.2875 changed to 32.3465
- Practice expense RVU 4.78 changed to 4.69
- Malpractice RVU 0.37 changed to 0.38
Held through RVU25B, RVU25C, RVU25D.
March 9, 2024
RVU24AR
$251.01changed to$255.18
- Conversion factor 32.7442 changed to 33.2875
Held through RVU24B, RVU24C, RVU24D.
January 1, 2024
RVU24A
$262.94changed to$251.01
- Conversion factor 33.8872 changed to 32.7442
- Practice expense RVU 4.82 changed to 4.78
- Malpractice RVU 0.36 changed to 0.37
- Work GPCI 1.007 changed to 1.009
- Practice expense GPCI 1.007 changed to 0.992
- Malpractice GPCI 0.938 changed to 0.949
January 1, 2023
RVU23A
$268.62changed to$262.94
- Conversion factor 34.6062 changed to 33.8872
- Practice expense RVU 4.77 changed to 4.82
- Malpractice RVU 0.35 changed to 0.36
- Work GPCI 1.005 changed to 1.007
- Practice expense GPCI 1.022 changed to 1.007
- Malpractice GPCI 0.927 changed to 0.938
Held through RVU23B, RVU23C, RVU23D.
January 1, 2022
RVU22A
$266.24changed to$268.62
- Conversion factor 34.8931 changed to 34.6062
- Practice expense RVU 4.65 changed to 4.77
- Malpractice RVU 0.34 changed to 0.35
Held through RVU22B, RVU22C, RVU22D.
January 1, 2021
RVU21A
$262.84changed to$266.24
- Conversion factor 36.0896 changed to 34.8931
- Practice expense RVU 4.27 changed to 4.65
- Malpractice RVU 0.35 changed to 0.34
- Work GPCI 1.006 changed to 1.005
- Practice expense GPCI 1.021 changed to 1.022
- Malpractice GPCI 1.023 changed to 0.927
Held through RVU21B, RVU21C, RVU21D.
January 1, 2020
RVU20A
$260.24changed to$262.84
- Conversion factor 36.0391 changed to 36.0896
- Practice expense RVU 4.16 changed to 4.27
- Malpractice RVU 0.37 changed to 0.35
- Work GPCI 1.007 changed to 1.006
- Practice expense GPCI 1.019 changed to 1.021
- Malpractice GPCI 1.119 changed to 1.023
Held through RVU20B, RVU20C, RVU20D.
July 1, 2019
RVU19C
$259.83changed to$260.24
- Malpractice RVU 0.36 changed to 0.37
Held through RVU19D.
January 1, 2019
RVU19A
$253.68changed to$259.83
- Conversion factor 35.9996 changed to 36.0391
- Practice expense RVU 4.00 changed to 4.16
Held through RVU19B.
January 1, 2018
RVU18AR1
$257.48changed to$253.68
- Conversion factor 35.8887 changed to 35.9996
- Practice expense RVU 4.10 changed to 4.00
- Work GPCI 1.010 changed to 1.007
- Practice expense GPCI 1.025 changed to 1.019
- Malpractice GPCI 1.101 changed to 1.119
Held through RVU18B, RVU18C, RVU18D.
January 1, 2017
RVU17A
$261.41changed to$257.48
- Conversion factor 35.8043 changed to 35.8887
- Practice expense RVU 4.19 changed to 4.10
- Malpractice RVU 0.37 changed to 0.36
- Work GPCI 1.012 changed to 1.010
- Practice expense GPCI 1.031 changed to 1.025
- Malpractice GPCI 1.083 changed to 1.101
Held through RVU17B, RVU17C, RVU17D.
January 1, 2016
RVU16A
$260.13changed to$261.41
- Conversion factor 35.9335 changed to 35.8043
- Practice expense RVU 4.13 changed to 4.19
Held through RVU16B, RVU16C, RVU16D.
July 1, 2015
RVU15C
$258.84changed to$260.13
- Conversion factor 35.7547 changed to 35.9335
Held through RVU15D.
January 1, 2015
RVU15A
$259.43changed to$258.84
- Conversion factor 35.8228 changed to 35.7547
- Practice expense RVU 4.22 changed to 4.13
- Malpractice RVU 0.32 changed to 0.37
- Practice expense GPCI 1.038 changed to 1.031
- Malpractice GPCI 0.878 changed to 1.083
Held through RVU15B.
January 1, 2014
RVU14A
$261.22changed to$259.43
- Conversion factor 34.0230 changed to 35.8228
- Practice expense RVU 4.67 changed to 4.22
- Malpractice RVU 0.33 changed to 0.32
- Practice expense GPCI 1.044 changed to 1.038
- Malpractice GPCI 0.672 changed to 0.878
Held through RVU14B, RVU14C, RVU14D.
January 1, 2013
RVU13AR
Earliest loaded release: $261.22
Held through RVU13B, RVU13C, RVU13D.
| Effective from | Office | Facility | CMS release |
|---|---|---|---|
| 2026-10-01 | $252.13 | $166.99 | RVU26D |
| 2026-07-01 | $252.13 | $166.99 | RVU26C |
| 2026-04-01 | $252.13 | $166.99 | RVU26B |
| 2026-01-01 | $252.13 | $166.99 | RVU26A |
| 2025-10-01 | $245.38 | $183.77 | RVU25D |
| 2025-07-01 | $245.38 | $183.77 | RVU25C |
| 2025-04-01 | $245.38 | $183.77 | RVU25B |
| 2025-01-01 | $245.38 | $183.77 | RVU25A |
| 2024-10-01 | $255.18 | $188.14 | RVU24D |
| 2024-07-01 | $255.18 | $188.14 | RVU24C |
| 2024-04-01 | $255.18 | $188.14 | RVU24B |
| 2024-03-09 | $255.18 | $188.14 | RVU24AR |
| 2024-01-01 | $251.01 | $185.07 | RVU24A |
| 2023-10-01 | $262.94 | $191.28 | RVU23D |
| 2023-07-01 | $262.94 | $191.28 | RVU23C |
| 2023-04-01 | $262.94 | $191.28 | RVU23B |
| 2023-01-01 | $262.94 | $191.28 | RVU23A |
| 2022-10-01 | $268.62 | $192.22 | RVU22D |
| 2022-07-01 | $268.62 | $192.22 | RVU22C |
| 2022-04-01 | $268.62 | $192.22 | RVU22B |
| 2022-01-01 | $268.62 | $192.22 | RVU22A |
| 2021-10-01 | $266.24 | $189.57 | RVU21D |
| 2021-07-01 | $266.24 | $189.57 | RVU21C |
| 2021-04-01 | $266.24 | $189.57 | RVU21B |
| 2021-01-01 | $266.24 | $189.57 | RVU21A |
| 2020-10-01 | $262.84 | $193.20 | RVU20D |
| 2020-07-01 | $262.84 | $193.20 | RVU20C |
| 2020-04-01 | $262.84 | $193.20 | RVU20B |
| 2020-01-01 | $262.84 | $193.20 | RVU20A |
| 2019-10-01 | $260.24 | $194.13 | RVU19D |
| 2019-07-01 | $260.24 | $194.13 | RVU19C |
| 2019-04-01 | $259.83 | $193.73 | RVU19B |
| 2019-01-01 | $259.83 | $193.73 | RVU19A |
| 2018-10-01 | $253.68 | $192.05 | RVU18D |
| 2018-07-01 | $253.68 | $192.05 | RVU18C |
| 2018-04-01 | $253.68 | $192.05 | RVU18B |
| 2018-01-01 | $253.68 | $192.05 | RVU18AR1 |
| 2017-10-01 | $257.48 | $194.57 | RVU17D |
| 2017-07-01 | $257.48 | $194.57 | RVU17C |
| 2017-04-01 | $257.48 | $194.57 | RVU17B |
| 2017-01-01 | $257.48 | $194.57 | RVU17A |
| 2016-10-01 | $261.41 | $197.55 | RVU16D |
| 2016-07-01 | $261.41 | $197.55 | RVU16C |
| 2016-04-01 | $261.41 | $197.55 | RVU16B |
| 2016-01-01 | $261.41 | $197.55 | RVU16A |
| 2015-10-01 | $260.13 | $197.15 | RVU15D |
| 2015-07-01 | $260.13 | $197.15 | RVU15C |
| 2015-04-01 | $258.84 | $196.17 | RVU15B |
| 2015-01-01 | $258.84 | $196.17 | RVU15A |
| 2014-10-01 | $259.43 | $194.73 | RVU14D |
| 2014-07-01 | $259.43 | $194.73 | RVU14C |
| 2014-04-01 | $259.43 | $194.73 | RVU14B |
| 2014-01-01 | $259.43 | $194.73 | RVU14A |
| 2013-10-01 | $261.22 | $191.96 | RVU13D |
| 2013-07-01 | $261.22 | $191.96 | RVU13C |
| 2013-04-01 | $261.22 | $191.96 | RVU13B |
| 2013-01-01 | $261.22 | $191.96 | RVU13AR |
Where the Delaware rate applies
Delaware is a Medicare payment area, not a city. Our Census mapping connects it to 79 cities and communities in Delaware. Some span more than one payment area; confirm with the service ZIP.
- Arden
- Ardencroft
- Ardentown
- Bear
- Bellefonte
- Bethany Beach
- Bethel
- Blades
42180 billing questions
How does this code differ from 42182?
Use 42180 for a palatal laceration under 2 cm. Check the complete descriptor and documented operative work before selecting 42182 for a different palate repair.
Can a palatal biopsy or lesion excision be reported as this repair?
No. This code describes closure of a laceration; biopsy and lesion excision are different services, even when performed on the palate.
Are related postoperative visits separately reported?
Related postoperative visits during the 10-day global period are included in the procedure's global service.
Should modifier 50 be used for a wound involving both sides of the palate?
No. Modifier 50 is inappropriate for this code; document the laceration and repair performed.
When is an assistant at surgery payable?
Only when the record documents medical necessity for the assistant. 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
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