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

In Washington, DC area, Medicare pays $1,076.43 for 42210 in a facility. There’s no office rate.

Check a contract rate as a % of Medicare · 42210 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 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.

How Washington, DC area compares for 42210

Across 109 of 109 payment localities, the facility rate for 42210 runs from $871.23 in Arkansas to $1,199.52 in Alaska. Washington, DC area pays $1,076.43. The RVUs are the same everywhere; the geographic indexes change the dollars.

Every other payment area

42210 rates by state

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

See 42210 in every payment locality

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.

Payment rules and modifiers for 42210

42210 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 42210

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

How 42210 has changed in Washington, DC area

Price 42210 for an earlier date of service

Where the Washington, DC area rate applies

Washington, DC area is a Medicare payment area, not a city. Our Census mapping connects it to 1 cities and communities in District of Columbia. Some span more than one payment area; confirm with the service ZIP.

• Washington

Browse all communities in District of Columbia

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