CPT code 42200: Cleft palate repair, soft and/or hard palate2026 Medicare rate & RVUs in Montana

In Montana, Medicare pays $842.55 for 42200 in a facility. There’s no office rate.

Check a contract rate as a % of Medicare · 42200 nationwide

Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.

What 42200 covers

Code 42200 describes surgical reconstruction to close a cleft in the soft palate, hard palate, or both. A plastic, craniofacial, oral and maxillofacial, or otolaryngology surgeon typically performs the operation under general anesthesia in a hospital or other surgical facility. The operative approach brings the separated palatal tissues together to restore continuity between the oral and nasal cavities.

Select this code when the documented repair is confined to the palate and does not include alveolar ridge closure or bone grafting there. The operative report should identify the cleft anatomy and the tissues repaired. CMS classifies the service as major surgery: the day-before preoperative visit and 90 days of related postoperative care are included. When multiple procedures occur in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard multiple procedure reduction. An assistant at surgery may be paid; co-surgeon and team-surgery payment are not permitted. Modifier 50 is inappropriate for this repair.

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 Montana compares for 42200

Across 109 of 109 payment localities, the facility rate for 42200 runs from $755.35 in Arkansas to $1,036.06 in Alaska. Montana pays $842.55. The RVUs are the same everywhere; the geographic indexes change the dollars.

Every other payment area

42200 rates by state

Office rate range in each state. Select a state to see its payment localities.

See 42200 in every payment locality

How the 42200 rate is calculated

Each of 42200’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.

Payment rules and modifiers for 42200

42200 has a 90-day global period: related visits in that window are included in the surgery payment.

What modifiers do to the payment

When to use modifier 51

Codes related to 42200

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

How 42200 has changed in Montana

Price 42200 for an earlier date of service

Where the Montana rate applies

Montana is a Medicare payment area, not a city. Our Census mapping connects it to 497 cities and communities in Montana. Some span more than one payment area; confirm with the service ZIP.

• Absarokee
• Acton
• Alberton
• Alder
• Alzada
• Amsterdam
• Anaconda-Deer Lodge County
• Antelope

Browse all communities in Montana

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

Open CMS sourceHow we calculate rates