CPT code 42220: Cleft palate repair, secondary muscle reconstruction2026 Medicare rate & RVUs in Texas
Reports secondary cleft palate surgery that reconstructs palatal muscle, often to address persistent velopharyngeal dysfunction after an earlier repair.
CMS doesn’t publish an office rate for 42220 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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On this page 9 sections
What 42220 covers
This service is a secondary operation on a previously repaired cleft palate, with dissection and reconstruction of palatal muscle, commonly the levator muscle sling. Cleft and craniofacial surgeons typically perform it in an operating room. A common clinical context is persistent velopharyngeal dysfunction, such as hypernasal speech, after an earlier palate repair; the operative plan must include muscle reconstruction rather than only local tissue rearrangement or palate lengthening.
Report the code when the operative record supports secondary cleft palate reconstruction with muscle work. Document the prior repair, the muscle anatomy addressed, and the reconstruction performed. CMS assigns a 90-day global period, including 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 other procedures are subject to the standard 50% reduction. The operation is not billed bilaterally with modifier 50. 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 42220 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 | $550.19 |
| Beaumont, TX | Unavailable | $512.68 |
| Brazoria, TX | Unavailable | $529.37 |
| Dallas, TX | Unavailable | $534.31 |
| Fort Worth, TX | Unavailable | $532.24 |
| Galveston, TX | Unavailable | $531.98 |
| Houston, TX | Unavailable | $555.78 |
| Rest of Texas | Unavailable | $521.81 |
How the 42220 rate is calculated
Each of 42220’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 · 42220
RVUs × geographic indexes × conversion factor
Work6.98
6.98 RVUs× 1.000 GPCI
Practice expense7.87
7.87 RVUs× 1.000 GPCI
Malpractice1.30
1.30 RVUs× 1.000 GPCI
Adjusted RVUs
16.1500
Conversion factor
$33.4009
Medicare rate
$539.42
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 42220
42220 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 42220
Cleft palate repair, secondary muscle reconstruction
| 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 · 42220
Cleft palate repair, secondary muscle reconstruction
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
42220 without 51 · national facility
$539.42
Cleft palate repair, secondary muscle reconstruction
42220-51 · Second procedure: 50%
$269.71
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%).
42220 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 42210Cleft palate repairAlveolar ridge bone graft
- Choose 42210 for secondary repair by local flap when palatal muscle reconstruction is not the defining work. Choose 42220 when the operation reconstructs palatal muscle.
- 42215Cleft palate repairSecondary intravelar veloplasty
- 42215 represents secondary cleft palate repair with extensive reconstruction. 42220 is distinguished by reconstruction of palatal muscle.
- 42200Cleft palate repairSoft and/or hard palate
- 42200 describes cleft palate repair with soft-tissue closure of the alveolar ridge, rather than secondary muscle reconstruction.
42220 billing questions
How is 42220 different from a secondary local-flap repair?
Use 42220 when the secondary cleft palate operation includes reconstruction of palatal muscle. A repair limited to local flap work is represented by 42210.
How does 42220 differ from 42215?
42220 identifies secondary reconstruction involving palatal muscle. 42215 is the neighboring code for secondary repair involving extensive reconstruction; the operative technique and documented work determine the selection.
Are routine postoperative visits separately reported?
Related postoperative care for 90 days is included in the global period, as is the day-before preoperative visit.
Can 42220 be reported with another procedure performed in the same session?
When multiple procedures are performed in the same session, CMS pays the highest-valued procedure in full and applies the standard 50% reduction to the others.
Can modifier 50 or a co-surgeon arrangement be used?
No. The service is not subject to bilateral adjustment, and CMS does not permit co-surgeons or team surgery for this code. An assistant at surgery may be paid.
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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