CPT code 42215: Cleft palate repair, secondary intravelar veloplasty2026 Medicare rate & RVUs in Texas
Reports secondary cleft palate reconstruction with repositioning of palatal muscles, commonly performed to improve palatal function after an earlier repair.
CMS doesn’t publish an office rate for 42215 in Texas.
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 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.
Where 42215 pays more and less in Texas
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
8 of 8 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Austin, TX | Unavailable | $660.85 |
| Beaumont, TX | Unavailable | $617.97 |
| Brazoria, TX | Unavailable | $636.63 |
| Dallas, TX | Unavailable | $642.68 |
| Fort Worth, TX | Unavailable | $640.37 |
| Galveston, TX | Unavailable | $639.85 |
| Houston, TX | Unavailable | $669.68 |
| Rest of Texas | Unavailable | $628.32 |
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.
How the rate is built · 42215
RVUs × geographic indexes × conversion factor
Work8.77
8.77 RVUs× 1.000 GPCI
Practice expense9.03
9.03 RVUs× 1.000 GPCI
Malpractice1.63
1.63 RVUs× 1.000 GPCI
Adjusted RVUs
19.4300
Conversion factor
$33.4009
Medicare rate
$648.98
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 42215
42215 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 42215
Cleft palate repair, secondary intravelar veloplasty
| 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 · 42215
Cleft palate repair, secondary intravelar veloplasty
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
42215 without 51 · national facility
$648.98
Cleft palate repair, secondary intravelar veloplasty
42215-51 · Second procedure: 50%
$324.49
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%).
42215 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 42200Cleft palate repairSoft and/or hard palate
- 42200 is for a limited primary or secondary cleft palate repair. Use 42215 when the secondary repair includes the muscle repositioning specified for that code.
- 42205Cleft palate revisionMajor revision
- 42205 describes an extensive primary or secondary repair. 42215 identifies secondary reconstruction with muscle repositioning rather than extent alone.
- 42210Cleft palate repairAlveolar ridge bone graft
- 42210 includes bone grafting to the alveolus. 42215 is the secondary repair with muscle repositioning; select based on the procedure actually documented.
- 42220Cleft palate repairSecondary muscle reconstruction
- 42220 involves a pharyngeal flap in secondary cleft palate repair. 42215 describes secondary repair with muscle repositioning.
42215 billing questions
How does 42215 differ from 42200 or 42205?
42215 identifies a secondary cleft palate repair with muscle repositioning. Choose between 42200 and 42205 based on the limited or extensive repair described by those codes, not simply because the patient has a cleft palate.
How does 42215 differ from 42220?
42215 describes secondary repair with muscle repositioning. 42220 describes a secondary repair involving a pharyngeal flap, so the documented operative technique determines the choice.
What documentation supports reporting 42215?
The operative report should establish that this is a secondary cleft palate reconstruction and describe repositioning of the palatal muscles. A diagnosis of cleft palate alone does not establish the specific procedure.
Does the 90-day global period include related postoperative care?
Yes. The global period includes the day-before preoperative visit and 90 days of related postoperative care.
Can 42215 be billed with modifier 50?
No. The CMS bilateral adjustment does not apply to this code, and modifier 50 is inappropriate.
Can an assistant or co-surgeon be reported?
An assistant at surgery may be paid. Co-surgeons and team surgery are not permitted under the CMS rules for this code.
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
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