CPT code 42225: Cleft palate repair, secondary lengthening procedure2026 Medicare rate & RVUs

Medicare pays $969.29 for 42225 nationally in a facility.

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

What 42225 covers

This operation addresses a previously repaired cleft palate when additional palatal length is needed, often to improve separation of the oral and nasal cavities and speech-related function. A plastic, oral and maxillofacial, or other surgeon experienced in cleft and craniofacial surgery typically performs it in an operating room. A pharyngeal flap is a recognized example of a secondary lengthening approach associated with this code.

Select the code when the operative report supports secondary cleft-palate reconstruction involving lengthening, rather than an initial repair or a different palate-lengthening service. Document the prior cleft repair, the functional or anatomic problem, the technique, and the structures treated. Medicare includes the day-before preoperative visit and 90 days of related postoperative care in the major-surgery global period. For multiple procedures in one session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% reduction. Modifier 50 is inappropriate; an assistant at surgery may be paid, but 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 42225 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

42225 rates by state

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

How the 42225 rate is calculated

Each of 42225’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 42225

42225 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

42225 compared with similar codes

How to choose

42200Cleft palate repairSoft and/or hard palate

Use 42200 for the specified soft- and/or hard-palate cleft repair. This code is for secondary cleft-palate reconstruction involving lengthening.

42205Cleft palate revisionMajor revision

Use 42205 when the documented cleft-palate operation is a major revision; use this code when the service is a secondary lengthening procedure.

42226Palate lengtheningIsland flap technique

42226 is a palate-lengthening code associated with closure of nasopharyngeal incompetence, with or without fistula closure. This code is specific to secondary lengthening in cleft-palate reconstruction.

Codes related to 42225

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

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