CPT code 42205: Cleft palate revision, major revision2026 Medicare rate & RVUs in Missouri
Reports major reconstructive revision of a previously repaired cleft palate when the operative work exceeds routine palatoplasty.
CMS doesn’t publish an office rate for 42205 in Missouri.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
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What 42205 covers
Code 42205 represents major revision of a previously repaired cleft palate, rather than routine initial closure. A craniofacial or plastic surgeon, and sometimes an otolaryngologist with cleft palate expertise, performs the reconstruction in an operating room. The operative report should identify the prior repair, the palatal anatomy revised, and the extent of reconstructive work supporting a major revision.
Report the service for the major revision, not for routine repair alone. CMS assigns a 90-day global period: the day-before preoperative visit and related postoperative care during the 90 days are included. If another procedure subject to multiple-procedure reduction is performed in the same session, the highest-valued procedure is paid in full and the others at 50%. Modifier 50 is inappropriate for this code. An assistant at surgery may be paid; 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.
Where 42205 pays more and less in Missouri
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
| Payment locality | Office | Facility |
|---|---|---|
| Metropolitan Kansas City, MO | Unavailable | $845.42 |
| Metropolitan St. Louis, MO | Unavailable | $851.92 |
| Rest of Missouri | Unavailable | $818.97 |
How the 42205 rate is calculated
Each of 42205’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 · 42205
RVUs × geographic indexes × conversion factor
Work13.32
13.32 RVUs× 1.000 GPCI
Practice expense10.19
10.19 RVUs× 1.000 GPCI
Malpractice2.48
2.48 RVUs× 1.000 GPCI
Adjusted RVUs
25.9900
Conversion factor
$33.4009
Medicare rate
$868.09
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 42205
42205 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 42205
Cleft palate revision, major revision
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 090 | Major surgery: the day before, the day of, and 90 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) | 2 | Paid. |
| 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) | 0.09/0.81/0.10 | Share of the payment for pre-op, the procedure itself, and post-op care. |
Global surgery period · 42205
Cleft palate revision, major revision
90-day global period ends
Dec 30, 2026
Covers Sep 30, 2026 through Dec 30, 2026 (92 days, including the day before surgery).
Visit on Oct 31, 2026
Day 30 of the 90-day post-op period: related follow-up care is included in the surgical payment.
Pre-op dayGlobal period
What modifiers do to the payment
Modifier 51 · payment effect
With and without the modifier
42205 without 51 · national facility
$868.09
Cleft palate revision, major revision
42205-51 · Second procedure: 50%
$434.05
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%).
42205 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 42200Cleft palate repairSoft and/or hard palate
- Use 42200 for palatoplasty limited to the soft and/or hard palate. 42205 identifies a major revision of a previous cleft palate repair.
- 42210Cleft palate repairAlveolar ridge bone graft
- 42210 describes cleft palate repair with alveolar ridge closure and bone grafting. Choose based on that specified procedure rather than the major-revision work represented by 42205.
- 42215Cleft palate repairSecondary intravelar veloplasty
- 42215 is a secondary cleft palate repair that includes a pharyngeal flap. 42205 represents major revision without that specific procedure defining the code.
42205 billing questions
How does 42205 differ from 42200?
42205 is for a major revision of a prior cleft palate repair. Use 42200 for palatoplasty limited to the soft and/or hard palate without the major-revision distinction.
What documentation supports reporting 42205?
Document the prior cleft repair, the residual or recurrent anatomy being revised, and the operative work performed. The record should support why this was a major revision rather than routine palatoplasty.
Is routine postoperative care separately reported?
Related postoperative care during the 90-day global period is included, as is the day-before preoperative visit.
Can modifier 50 be appended?
No. CMS identifies bilateral adjustment as inappropriate for this code.
Can an assistant or another surgeon be reported?
An assistant at surgery may be paid. Co-surgeons and team surgery are not permitted.
How are other procedures in the same session paid?
Under the standard multiple-procedure reduction, the highest-valued procedure is paid in full and other procedures subject to the reduction are paid at 50%.
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
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