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CPT code 42180: Palate repair, laceration under 2 cm2026 Medicare rate & RVUs in Houston, TX

Repair a palatal laceration measuring less than 2 cm, typically after oral trauma, when the clinician closes the wound rather than excising a lesion.

CMS RVU26DEffective Oct 1, 2026One payment locality12 Medicare services in 2024

In Houston, TX, Medicare pays $258.92 for 42180 in the office and $173.35 when it’s performed in a hospital or facility.

$258.92Office (non-facility)
$173.35Hospital or facility
+1.6%vs the national office rate ($254.85)

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.

We’ll open 42180 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in Houston, TX
  2. What 42180 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 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 Houston, TX 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. Houston, TX pays $258.92. The RVUs are the same everywhere; the geographic indexes change the dollars.

42180 in Houston, TX vs other payment areas
  1. Houston, TX · this page$258.92
  2. Austin, TX · Texas$262.90+$3.98
  3. Beaumont, TX · Texas$239.63−$19.29
  4. Brazoria, TX · Texas$251.43−$7.49
  5. Dallas, TX · Texas$253.25−$5.67
  6. Fort Worth, TX · Texas$251.81−$7.11
  7. Galveston, TX · Texas$252.33−$6.59

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

Every other payment area

42180 in every other Medicare payment locality
Payment localityOfficeFacility
Rest of TexasTexas$245.54$163.76
Los Angeles, CACalifornia$283.44$181.49
Washington, DC areaDistrict of Columbia$289.12$187.60
Miami, FLFlorida$279.78$190.07
Chicago, ILIllinois$271.80$185.20
Manhattan, NYNew York$293.08$192.95
AlaskaAlaska$301.41$209.64
AlabamaAlabama$229.67$154.27

42180 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.

$226.51

$301.41

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

View every state and territory as a table
42180 office rate range by state
State / territoryOffice rate rangeLocalities
AK$301.411
AL$229.671
AR$226.511
AZ$248.171
CA$266.01–$328.9929
CO$263.431
CT$271.331
DC$289.121
DE$252.131
FL$253.87–$279.783
GA$239.91–$260.072
GU$271.661
HI$271.661
IA$234.031
ID$235.741
IL$247.73–$271.804
IN$237.011
KS$233.561
KY$236.101
LA$235.98–$247.062
MA$262.20–$287.912
MD$256.61–$289.123
ME$237.53–$248.972
MI$242.51–$257.512
MN$251.011
MO$232.50–$247.213
MS$229.521
MT$254.821
NC$239.811
ND$247.711
NE$235.081
NH$259.891
NJ$274.03–$286.452
NM$244.011
NV$253.001
NY$243.29–$300.655
OH$241.051
OK$235.081
OR$250.64–$270.822
PA$241.10–$265.212
PR$256.421
RI$260.401
SC$240.911
SD$246.861
TN$234.751
TX$239.63–$262.908
UT$244.041
VA$248.60–$289.122
VI$256.421
VT$247.311
WA$261.52–$293.052
WI$239.821
WV$239.121
WY$251.721

See 42180 in every payment locality

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

Office or facility?

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 Houston, TX 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

102

Locality
Houston, TX
Physician work
1.008
Practice expense
0.993
Malpractice
1.376
Office calculation for 42180 in Houston, TX
ComponentRVULocality factorAdjusted
Physician work2.49× 1.0082.5099
Practice expense4.78× 0.9934.7465
Malpractice0.36× 1.3760.4954
Total RVUs7.7518
Conversion factor× 33.4009

Office rate, Houston, TX$258.92

Office: (2.49 × 1.008 + 4.78 × 0.993 + 0.36 × 1.376) × $33.4009 = $258.92

Facility: (2.49 × 1.008 + 2.2 × 0.993 + 0.36 × 1.376) × $33.4009 = $173.35

Open 42180 in the RVU calculator

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

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 · 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.

SurgeryVisit
Sep 28, 2026Oct 14, 2026

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%).

When to use modifier 51

Codes related to 42180

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

Codes related to 42180
CodeHow it relatesOffice range, Houston, TX
Same family
42182Palate repair, laceration 2 cm or greaterA related palate-repair code; distinguish it by its full descriptor and the documented repair performed.$335.49
42145Palatopharyngoplasty, palate and pharynx repairPalatal and pharyngeal reconstructive surgery, rather than a short traumatic laceration closure.No office rate
Used instead
42120Palate resection, extensive lesion or palateUsed for palate resection in a different operative circumstance, not closure of a laceration.No office rate

How 42180 has changed in Houston, TX

42180 · Office / nonfacility

$258.92

Effective 2026-10-01

The base rate is $5.80 higher than on 2025-10-01, moving from $253.12 to $258.92 (2.3%).

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

    $253.12changed to$258.92

    • 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 1.014 changed to 1.008
    • Practice expense GPCI 1.003 changed to 0.993
    • Malpractice GPCI 1.409 changed to 1.376

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $263.02changed to$253.12

    • 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.

  3. March 9, 2024

    RVU24AR

    $258.72changed to$263.02

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $268.43changed to$258.72

    • 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 1.023 changed to 1.014
    • Practice expense GPCI 1.016 changed to 1.003
    • Malpractice GPCI 1.154 changed to 1.409

  5. January 1, 2023

    RVU23A

    $271.83changed to$268.43

    • 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 1.032 changed to 1.023
    • Practice expense GPCI 1.029 changed to 1.016
    • Malpractice GPCI 0.900 changed to 1.154

    Held through RVU23B, RVU23C, RVU23D.

  6. January 1, 2022

    RVU22A

    $269.46changed to$271.83

    • 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.

  7. January 1, 2021

    RVU21A

    $263.20changed to$269.46

    • 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 1.026 changed to 1.032
    • Practice expense GPCI 1.020 changed to 1.029
    • Malpractice GPCI 0.918 changed to 0.900

    Held through RVU21B, RVU21C, RVU21D.

  8. January 1, 2020

    RVU20A

    $257.94changed to$263.20

    • 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 1.020 changed to 1.026
    • Practice expense GPCI 1.012 changed to 1.020
    • Malpractice GPCI 0.936 changed to 0.918

    Held through RVU20B, RVU20C, RVU20D.

  9. July 1, 2019

    RVU19C

    $257.60changed to$257.94

    • Malpractice RVU 0.36 changed to 0.37

    Held through RVU19D.

  10. January 1, 2019

    RVU19A

    $251.49changed to$257.60

    • Conversion factor 35.9996 changed to 36.0391
    • Practice expense RVU 4.00 changed to 4.16

    Held through RVU19B.

  11. January 1, 2018

    RVU18AR1

    $254.04changed to$251.49

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 4.10 changed to 4.00
    • Practice expense GPCI 1.009 changed to 1.012
    • Malpractice GPCI 0.946 changed to 0.936

    Held through RVU18B, RVU18C, RVU18D.

  12. January 1, 2017

    RVU17A

    $256.61changed to$254.04

    • 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 1.019 changed to 1.020
    • Practice expense GPCI 1.006 changed to 1.009
    • Malpractice GPCI 0.955 changed to 0.946

    Held through RVU17B, RVU17C, RVU17D.

  13. January 1, 2016

    RVU16A

    $255.36changed to$256.61

    • Conversion factor 35.9335 changed to 35.8043
    • Practice expense RVU 4.13 changed to 4.19

    Held through RVU16B, RVU16C, RVU16D.

  14. July 1, 2015

    RVU15C

    $254.09changed to$255.36

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  15. January 1, 2015

    RVU15A

    $255.17changed to$254.09

    • 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
    • Work GPCI 1.014 changed to 1.019
    • Practice expense GPCI 1.004 changed to 1.006
    • Malpractice GPCI 0.939 changed to 0.955

    Held through RVU15B.

  16. January 1, 2014

    RVU14A

    $257.11changed to$255.17

    • 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
    • Work GPCI 1.009 changed to 1.014
    • Practice expense GPCI 1.002 changed to 1.004
    • Malpractice GPCI 0.923 changed to 0.939

    Held through RVU14B, RVU14C, RVU14D.

  17. January 1, 2013

    RVU13AR

    Earliest loaded release: $257.11

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$258.92$173.35RVU26D
2026-07-01$258.92$173.35RVU26C
2026-04-01$258.92$173.35RVU26B
2026-01-01$258.92$173.35RVU26A
2025-10-01$253.12$190.83RVU25D
2025-07-01$253.12$190.83RVU25C
2025-04-01$253.12$190.83RVU25B
2025-01-01$253.12$190.83RVU25A
2024-10-01$263.02$195.24RVU24D
2024-07-01$263.02$195.24RVU24C
2024-04-01$263.02$195.24RVU24B
2024-03-09$263.02$195.24RVU24AR
2024-01-01$258.72$192.05RVU24A
2023-10-01$268.43$196.13RVU23D
2023-07-01$268.43$196.13RVU23C
2023-04-01$268.43$196.13RVU23B
2023-01-01$268.43$196.13RVU23A
2022-10-01$271.83$194.91RVU22D
2022-07-01$271.83$194.91RVU22C
2022-04-01$271.83$194.91RVU22B
2022-01-01$271.83$194.91RVU22A
2021-10-01$269.46$192.26RVU21D
2021-07-01$269.46$192.26RVU21C
2021-04-01$269.46$192.26RVU21B
2021-01-01$269.46$192.26RVU21A
2020-10-01$263.20$193.63RVU20D
2020-07-01$263.20$193.63RVU20C
2020-04-01$263.20$193.63RVU20B
2020-01-01$263.20$193.63RVU20A
2019-10-01$257.94$192.29RVU19D
2019-07-01$257.94$192.29RVU19C
2019-04-01$257.60$191.95RVU19B
2019-01-01$257.60$191.95RVU19A
2018-10-01$251.49$190.29RVU18D
2018-07-01$251.49$190.29RVU18C
2018-04-01$251.49$190.29RVU18B
2018-01-01$251.49$190.29RVU18AR1
2017-10-01$254.04$192.11RVU17D
2017-07-01$254.04$192.11RVU17C
2017-04-01$254.04$192.11RVU17B
2017-01-01$254.04$192.11RVU17A
2016-10-01$256.61$194.29RVU16D
2016-07-01$256.61$194.29RVU16C
2016-04-01$256.61$194.29RVU16B
2016-01-01$256.61$194.29RVU16A
2015-10-01$255.36$193.91RVU15D
2015-07-01$255.36$193.91RVU15C
2015-04-01$254.09$192.95RVU15B
2015-01-01$254.09$192.95RVU15A
2014-10-01$255.17$192.59RVU14D
2014-07-01$255.17$192.59RVU14C
2014-04-01$255.17$192.59RVU14B
2014-01-01$255.17$192.59RVU14A
2013-10-01$257.11$190.63RVU13D
2013-07-01$257.11$190.63RVU13C
2013-04-01$257.11$190.63RVU13B
2013-01-01$257.11$190.63RVU13AR

Price 42180 for an earlier date of service

Where the Houston, TX rate applies

Houston, TX is a Medicare payment area, not a city. Our Census mapping connects it to 46 cities and communities in Texas. Some span more than one payment area; confirm with the service ZIP.

Browse all communities in Texas

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

Show the CMS file lines behind this rate
RVUs for 42180PPRRVU2026_Oct_nonQPP.csv, line 5,002 (RVU26D)
Geographic factors for Houston, TXGPCI2026.csv, line 102 (RVU26D)

Open CMS sourceHow we calculate rates

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