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CPT code 42210: Cleft palate repair, alveolar ridge bone graft2026 Medicare rate & RVUs

Reports cleft palate reconstruction that closes an alveolar ridge defect and includes bone grafting to the ridge as part of the repair.

CMS RVU26DEffective Oct 1, 2026109 payment localities

Medicare pays $970.30 for 42210 nationally in a facility.

Medicare rate · 42210

Cleft palate repair, alveolar ridge bone graft

Office or facility?

Work RVUs
14.65
Total RVUs
29.05
Global days
090

National rate · 2026

$970.30

Facility setting, before claim adjustments.

See every locality for 42210 →Billed by an NP, PA or therapist? →

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

Your location

Medicare pays by the payment locality where the service is performed.

On this page 10 sections
  1. Medicare rate
  2. What 42210 covers
  3. By payment locality
  4. Rate map
  5. How it’s calculated
  6. Payment rules
  7. Similar codes
  8. Related codes
  9. Billing questions
  10. Sources

What 42210 covers

This service reconstructs a cleft involving the palate and alveolar ridge, with bone grafting included in the operative repair. Plastic and craniofacial surgeons, oral and maxillofacial surgeons, or other surgeons experienced in cleft reconstruction typically perform it in an operating room. A common clinical situation is grafting an alveolar cleft to restore continuity of the ridge as part of staged cleft care.

Select this code when the operative record supports both alveolar ridge closure and bone grafting to that ridge; document the defect, graft site and reconstructive work. CMS assigns a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. For procedures in the same session, the highest-valued procedure is paid in full and others are subject to the standard 50% multiple-procedure reduction. Modifier 50 is inappropriate. Assistant-at-surgery payment may be available; co-surgeon and team-surgery billing are not permitted under the CMS rules for this code.

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 42210 pays more and less

The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.

109 of 109 payment localities

42210 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$882.10
AlaskaUnavailable$1,199.52
ArizonaUnavailable$945.12
ArkansasUnavailable$871.23
Atlanta, GAUnavailable$996.27
Austin, TXUnavailable$983.54
Bakersfield, CAUnavailable$981.52
Baltimore area, MDUnavailable$1,028.14
Beaumont, TXUnavailable$928.73
Brazoria, TXUnavailable$950.71

42210 rates by state

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

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Local rates. Clear comparisons.

Hover or focus a tile to see its rate range. Select it to open the state’s fee schedule.

View every state and territory as a table
42210 office rate range by state
State / territoryOffice rate rangeLocalities
AKNo published base rate1
ALNo published base rate1
ARNo published base rate1
AZNo published base rate1
CANo published base rate29
CONo published base rate1
CTNo published base rate1
DCNo published base rate1
DENo published base rate1
FLNo published base rate3
GANo published base rate2
GUNo published base rate1
HINo published base rate1
IANo published base rate1
IDNo published base rate1
ILNo published base rate4
INNo published base rate1
KSNo published base rate1
KYNo published base rate1
LANo published base rate2
MANo published base rate2
MDNo published base rate3
MENo published base rate2
MINo published base rate2
MNNo published base rate1
MONo published base rate3
MSNo published base rate1
MTNo published base rate1
NCNo published base rate1
NDNo published base rate1
NENo published base rate1
NHNo published base rate1
NJNo published base rate2
NMNo published base rate1
NVNo published base rate1
NYNo published base rate5
OHNo published base rate1
OKNo published base rate1
ORNo published base rate2
PANo published base rate2
PRNo published base rate1
RINo published base rate1
SCNo published base rate1
SDNo published base rate1
TNNo published base rate1
TXNo published base rate8
UTNo published base rate1
VANo published base rate2
VINo published base rate1
VTNo published base rate1
WANo published base rate2
WINo published base rate1
WVNo published base rate1
WYNo published base rate1

How the 42210 rate is calculated

Each of 42210’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 · 42210

RVUs × geographic indexes × conversion factor

Office or facility?

Work14.65

14.65 RVUs× 1.000 GPCI

Practice expense11.68

11.68 RVUs× 1.000 GPCI

Malpractice2.72

2.72 RVUs× 1.000 GPCI

Adjusted RVUs

29.0500

Conversion factor

$33.4009

Medicare rate

$970.30

Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.

Payment rules and modifiers for 42210

42210 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 42210

Cleft palate repair, alveolar ridge bone graft

RuleCMS valueWhat it means
Global period090Major surgery: the day before, the day of, and 90 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)2Paid.
Co-surgeons (62)0Not permitted.
Team surgery (66)0Not permitted.
Professional/technical0Physician service: no professional/technical split.
Split (54/55/56)0.09/0.81/0.10Share of the payment for pre-op, the procedure itself, and post-op care.

Global surgery period · 42210

Cleft palate repair, alveolar ridge bone graft

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.

  • 24Unrelated E/M visit by the same physician
  • 79Unrelated procedure (starts its own global period)
  • 58Staged, more extensive, or therapy procedure that was planned
  • 78Unplanned return to the operating room for a related complication
SurgeryVisit
Sep 23, 2026Jan 10, 2027

Pre-op dayGlobal period

What modifiers do to the payment

Modifier 51 · payment effect

With and without the modifier

42210 without 51 · national facility

$970.30

Cleft palate repair, alveolar ridge bone graft

42210-51 · Second procedure: 50%

$485.15

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

42210 compared with similar codes

Compare codes · National

4 codes, side by side

Office or facility?

  • 42210

    Cleft palate repair, alveolar ridge bone graft14.65 wRVU

    Not priced

  • 42205

    Cleft palate revision, major revision13.32 wRVU

    Not priced

  • 42200

    Cleft palate repair, soft and/or hard palate12.22 wRVU

    Not priced

  • 42215

    Cleft palate repair, secondary intravelar veloplasty8.77 wRVU

    Not priced

How to choose

42205Cleft palate revisionMajor revision
Choose 42210 when bone grafting to the alveolar ridge is part of the repair. 42205 represents ridge closure without that graft component.
42200Cleft palate repairSoft and/or hard palate
42200 is for a soft-tissue cleft palate repair. 42210 includes reconstruction of the alveolar ridge with bone grafting.
42215Cleft palate repairSecondary intravelar veloplasty
42215 is used for a major revision of cleft palate reconstruction; 42210 is selected for the alveolar ridge closure and bone grafting service described by the operative work.

Codes related to 42210

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

Codes related to 42210
CodeHow it relatesNational office range
Same family
42205Cleft palate revision, major revisionCleft palate reconstruction with alveolar ridge closure, but without the bone graft component.No office rate
42200Cleft palate repair, soft and/or hard palateCleft palate repair limited to soft tissue, without alveolar ridge bone grafting.No office rate
42215Cleft palate repair, secondary intravelar veloplastyA related cleft palate reconstruction code; distinguish by the specific revision work documented.No office rate

42210 billing questions

How is 42210 distinguished from 42205?

Use 42210 when the cleft palate reconstruction includes bone grafting to the alveolar ridge. 42205 describes ridge closure without that bone graft component.

Can the bone graft be billed separately?

The grafting to the alveolar ridge is included in 42210. Report a separate service only when a distinct, separately reportable procedure is supported and applicable coding rules allow it.

Should modifier 50 be used for a bilateral cleft?

No. CMS identifies bilateral adjustment as inappropriate for this code, so modifier 50 is not the way to report the repair.

What documentation supports 42210?

The operative report should establish the cleft-related alveolar ridge defect, closure of the ridge, and bone grafting performed as part of the reconstruction.

How does the 90-day global period affect postoperative visits?

The day-before preoperative visit and 90 days of related postoperative care are included in the global period.

Can an assistant surgeon be reported?

CMS permits assistant-at-surgery payment for this service. Co-surgeon and team-surgery billing are not permitted.

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 42210PPRRVU2026_Oct_nonQPP.csv, line 5,007 (RVU26D)

Open CMS sourceHow we calculate rates

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