CPT code 42227: Palate lengthening, with muscle repositioning2026 Medicare rate & RVUs in Washington, DC area

In Washington, DC area, Medicare pays $869.83 for 42227 in a facility. There’s no office rate.

Check a contract rate as a % of Medicare · 42227 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 42227 covers

This operation lengthens the palate while repositioning palatal muscle, generally to improve velopharyngeal function when the palate is too short or does not close adequately. It may be performed as secondary surgery for a patient with a history of cleft palate repair. Plastic and craniofacial surgeons, oral and maxillofacial surgeons, or otolaryngologists may perform the procedure in an operating room.

Report 42227 when the operative record supports palate lengthening with muscle repositioning, rather than a different palatal repair or lengthening procedure. Document the indication, prior palate history when relevant, and the specific surgical work performed. Medicare 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% multiple-procedure reduction. Bilateral adjustment is inappropriate for this palatal procedure. An assistant at surgery may be paid; co-surgeon and team-surgery billing 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 Washington, DC area compares for 42227

Across 109 of 109 payment localities, the facility rate for 42227 runs from $695.00 in Arkansas to $968.03 in San Benito County, CA. Washington, DC area pays $869.83. The RVUs are the same everywhere; the geographic indexes change the dollars.

Every other payment area

42227 rates by state

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

See 42227 in every payment locality

How the 42227 rate is calculated

Each of 42227’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 42227

42227 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 42227

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

How 42227 has changed in Washington, DC area

Price 42227 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

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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