CPT code 42215: Cleft palate repair, secondary intravelar veloplasty2026 Medicare rate & RVUs in New Mexico

In New Mexico, Medicare pays $634.89 for 42215 in a facility. There’s no office rate.

Check a contract rate as a % of Medicare · 42215 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 42215 covers

This operation repairs a previously treated cleft palate and repositions the palatal muscles as part of the reconstruction. It may be performed for a patient with persistent palatal dysfunction after an earlier cleft repair. Plastic surgeons, otolaryngologists, and oral and maxillofacial surgeons may perform the procedure, typically in an operating room. The operative report should identify the prior repair and document the muscle repositioning and reconstructive work performed.

Report 42215 when the documented procedure matches this secondary repair with muscle repositioning, rather than selecting a code based only on the diagnosis of cleft palate. The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care. When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and the others are subject to the standard multiple-procedure reduction. 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.

How New Mexico compares for 42215

Across 109 of 109 payment localities, the facility rate for 42215 runs from $580.05 in Arkansas to $790.60 in Alaska. New Mexico pays $634.89. The RVUs are the same everywhere; the geographic indexes change the dollars.

Every other payment area

42215 rates by state

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

See 42215 in every payment locality

How the 42215 rate is calculated

Each of 42215’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 42215

42215 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 42215

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

How 42215 has changed in New Mexico

Price 42215 for an earlier date of service

Where the New Mexico rate applies

New Mexico is a Medicare payment area, not a city. Our Census mapping connects it to 528 cities and communities in New Mexico. Some span more than one payment area; confirm with the service ZIP.

• Abeytas
• Abiquiu
• Acomita Lake
• Adelino
• Agua Fria
• Alamillo
• Alamo
• Alamogordo

Browse all communities in New Mexico

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