CPT code 42227: Palate lengthening, with muscle repositioning2026 Medicare rate & RVUs in Montana

Reports operative palate lengthening with muscle repositioning, typically to address a short palate or velopharyngeal dysfunction after cleft palate repair.

CMS RVU26DEffective Oct 1, 2026One payment locality

In Montana, Medicare pays $774.81 for 42227 in a facility. There’s no office rate.

Not available in this settingOffice (non-facility)
$774.81Hospital or facility

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.

We’ll open 42227 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in Montana
  2. What 42227 covers
  3. Compared with other areas
  4. Rate map
  5. How it’s calculated
  6. Payment rules
  7. Related codes
  8. Rate history
  9. Where it applies
  10. Billing questions
  11. Sources

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 Montana 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. Montana pays $774.81. The RVUs are the same everywhere; the geographic indexes change the dollars.

42227 in Montana vs other payment areas
  1. Montana · this page$774.81
  2. Los Angeles, CA · California$846.67+$71.86
  3. Washington, DC area · District of Columbia$869.83+$95.02
  4. Miami, FL · Florida$863.04+$88.23
  5. Chicago, IL · Illinois$839.74+$64.93
  6. Manhattan, NY · New York$888.67+$113.86
  7. Alaska · Alaska$941.44+$166.63

Other areas in Montana first, then benchmark localities. Bars start at $0.

Every other payment area

42227 in every other Medicare payment locality
Payment localityOfficeFacility
AlabamaAlabama—$703.88
ArkansasArkansas—$695.00
ArizonaArizona—$755.59
Bakersfield, CACalifornia—$801.70
Chico, CACalifornia—$797.64
El Centro, CACalifornia—$797.88
Fresno, CACalifornia—$797.64
Hanford, CACalifornia—$797.64

42227 rates by state

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

Explore a state

Local rates. Clear comparisons.

Hover or focus a tile to see its rate range. Select it to open the state’s fee schedule.

View every state and territory as a table
42227 office rate range by state
State / territoryOffice rate rangeLocalities
AKNo published base rate1
ALNo published base rate1
ARNo published base rate1
AZNo published base rate1
CANo published base rate29
CONo published base rate1
CTNo published base rate1
DCNo published base rate1
DENo published base rate1
FLNo published base rate3
GANo published base rate2
GUNo published base rate1
HINo published base rate1
IANo published base rate1
IDNo published base rate1
ILNo published base rate4
INNo published base rate1
KSNo published base rate1
KYNo published base rate1
LANo published base rate2
MANo published base rate2
MDNo published base rate3
MENo published base rate2
MINo published base rate2
MNNo published base rate1
MONo published base rate3
MSNo published base rate1
MTNo published base rate1
NCNo published base rate1
NDNo published base rate1
NENo published base rate1
NHNo published base rate1
NJNo published base rate2
NMNo published base rate1
NVNo published base rate1
NYNo published base rate5
OHNo published base rate1
OKNo published base rate1
ORNo published base rate2
PANo published base rate2
PRNo published base rate1
RINo published base rate1
SCNo published base rate1
SDNo published base rate1
TNNo published base rate1
TXNo published base rate8
UTNo published base rate1
VANo published base rate2
VINo published base rate1
VTNo published base rate1
WANo published base rate2
WINo published base rate1
WVNo published base rate1
WYNo published base rate1

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.

How the rate is built · 42227

RVUs × geographic indexes × conversion factor

Office or facility?

Work9.65

9.65 RVUs× 1.000 GPCI

Practice expense12.15

12.15 RVUs× 1.000 GPCI

Malpractice1.40

1.40 RVUs× 1.000 GPCI

Adjusted RVUs

23.2000

Conversion factor

$33.4009

Medicare rate

$774.90

Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.

The exact Montana inputs and CMS source lines

PPRRVU2026_Oct_nonQPP.csv

5,013

Code
42227
Physician work
9.65
Practice expense
12.15
Malpractice
1.40

GPCI2026.csv

71

Locality
Montana
Physician work
1.000
Practice expense
1.000
Malpractice
0.998
Facility calculation for 42227 in Montana
ComponentRVULocality factorAdjusted
Physician work9.65× 1.0009.6500
Practice expense12.15× 1.00012.1500
Malpractice1.40× 0.9981.3972
Total RVUs23.1972
Conversion factor× 33.4009

Facility rate, Montana$774.81

Facility: (9.65 × 1 + 12.15 × 1 + 1.4 × 0.998) × $33.4009 = $774.81

Open 42227 in the RVU calculator

Payment rules and modifiers for 42227

42227 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 42227

Palate lengthening, with muscle repositioning

RuleCMS valueWhat it means
Global period090Major surgery: the day before, the day of, and 90 days after are included.
Multiple procedures2Standard reduction: highest-valued procedure at 100%, others at 50%.
Bilateral (modifier 50)0The 150% bilateral adjustment doesn’t apply.
Assistant at surgery (80/81/82/AS)2Paid.
Co-surgeons (62)0Not permitted.
Team surgery (66)0Not permitted.
Professional/technical0Physician service: no professional/technical split.
Split (54/55/56)0.09/0.81/0.10Share of the payment for pre-op, the procedure itself, and post-op care.

Global surgery period · 42227

Palate lengthening, with muscle repositioning

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.

  • 24Unrelated E/M visit by the same physician
  • 79Unrelated procedure (starts its own global period)
  • 58Staged, more extensive, or therapy procedure that was planned
  • 78Unplanned return to the operating room for a related complication
SurgeryVisit
Sep 23, 2026Jan 10, 2027

Pre-op dayGlobal period

What modifiers do to the payment

Modifier 51 · payment effect

With and without the modifier

42227 without 51 · national facility

$774.90

Palate lengthening, with muscle repositioning

42227-51 · Second procedure: 50%

$387.45

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%).

When to use modifier 51

How 42227 has changed in Montana

42227 · Office / nonfacility

Rate unavailable

Effective 2026-10-01

A rate is unavailable in one of these releases, so a change cannot be calculated.

Base rate by release · bars start at $0 · select a bar to compare

One bar per available release, ordered by effective date. Missing rates remain gaps. These comparisons hold the code, setting and locality identifiers constant; they do not isolate which policy or input caused a change.

What changed, release by release
Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01Not available in this setting$774.81RVU26D
2026-07-01Not available in this setting$774.81RVU26C
2026-04-01Not available in this setting$774.81RVU26B
2026-01-01Not available in this setting$774.81RVU26A
2025-10-01Not available in this setting$823.82RVU25D
2025-07-01Not available in this setting$823.82RVU25C
2025-04-01Not available in this setting$823.82RVU25B
2025-01-01Not available in this setting$823.82RVU25A
2024-10-01Not available in this setting$844.77RVU24D
2024-07-01Not available in this setting$844.77RVU24C
2024-04-01Not available in this setting$844.77RVU24B
2024-03-09Not available in this setting$844.77RVU24AR
2024-01-01Not available in this setting$830.99RVU24A
2023-10-01Not available in this setting$860.04RVU23D
2023-07-01Not available in this setting$860.04RVU23C
2023-04-01Not available in this setting$860.04RVU23B
2023-01-01Not available in this setting$860.04RVU23A
2022-10-01Not available in this setting$870.27RVU22D
2022-07-01Not available in this setting$870.27RVU22C
2022-04-01Not available in this setting$870.27RVU22B
2022-01-01Not available in this setting$870.27RVU22A
2021-10-01Not available in this setting$863.20RVU21D
2021-07-01Not available in this setting$863.20RVU21C
2021-04-01Not available in this setting$863.20RVU21B
2021-01-01Not available in this setting$863.20RVU21A
2020-10-01Not available in this setting$868.22RVU20D
2020-07-01Not available in this setting$868.22RVU20C
2020-04-01Not available in this setting$868.22RVU20B
2020-01-01Not available in this setting$868.22RVU20A
2019-10-01Not available in this setting$891.60RVU19D
2019-07-01Not available in this setting$891.60RVU19C
2019-04-01Not available in this setting$891.60RVU19B
2019-01-01Not available in this setting$891.60RVU19A
2018-10-01Not available in this setting$888.91RVU18D
2018-07-01Not available in this setting$888.91RVU18C
2018-04-01Not available in this setting$888.91RVU18B
2018-01-01Not available in this setting$888.91RVU18AR1
2017-10-01Not available in this setting$908.78RVU17D
2017-07-01Not available in this setting$908.78RVU17C
2017-04-01Not available in this setting$908.78RVU17B
2017-01-01Not available in this setting$908.78RVU17A
2016-10-01Not available in this setting$902.01RVU16D
2016-07-01Not available in this setting$902.01RVU16C
2016-04-01Not available in this setting$902.01RVU16B
2016-01-01Not available in this setting$902.01RVU16A
2015-10-01Not available in this setting$885.76RVU15D
2015-07-01Not available in this setting$885.76RVU15C
2015-04-01Not available in this setting$881.35RVU15B
2015-01-01Not available in this setting$881.35RVU15A
2014-10-01Not available in this setting$873.71RVU14D
2014-07-01Not available in this setting$873.71RVU14C
2014-04-01Not available in this setting$873.71RVU14B
2014-01-01Not available in this setting$873.71RVU14A
2013-10-01Not available in this setting$875.78RVU13D
2013-07-01Not available in this setting$875.78RVU13C
2013-04-01Not available in this setting$875.78RVU13B
2013-01-01Not available in this setting$875.78RVU13AR

Price 42227 for an earlier date of service

Where the Montana rate applies

Montana is a Medicare payment area, not a city. Our Census mapping connects it to 497 cities and communities in Montana. Some span more than one payment area; confirm with the service ZIP.

  • Absarokee
  • Acton
  • Alberton
  • Alder
  • Alzada
  • Amsterdam
  • Anaconda-Deer Lodge County
  • Antelope

Browse all communities in Montana

42227 billing questions

How does 42227 differ from 42226?

Both are palate-lengthening procedures, but 42227 is the choice when the operative work includes muscle repositioning. Code 42226 describes a different palate-lengthening service; use the code that matches the documented operation.

What documentation supports 42227?

The operative report should identify the reason for lengthening and describe both the lengthening and palatal muscle repositioning performed. A diagnosis or history of cleft palate alone does not establish the specific procedure.

Does the 90-day global period include related follow-up?

Yes. The global period includes the day-before preoperative visit and 90 days of related postoperative care.

Can modifier 50 be used for bilateral work?

No. Bilateral adjustment is inappropriate for this palate procedure.

Can an assistant or co-surgeon be reported?

An assistant at surgery may be paid for this procedure. Co-surgeon and team-surgery billing are not permitted.

What happens if another procedure is performed in the same session?

Under the standard multiple-procedure rule, the highest-valued procedure is paid in full and the other procedure or procedures are subject to a 50% reduction.

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

Show the CMS file lines behind this rate
RVUs for 42227PPRRVU2026_Oct_nonQPP.csv, line 5,013 (RVU26D)
Geographic factors for MontanaGPCI2026.csv, line 71 (RVU26D)

Open CMS sourceHow we calculate rates

Did this answer your question about what 42227 pays in Montana?

Tell us what you were actually trying to work out. We’ll answer you directly, or build the page that does.

Fee sheets

Put 42227 and the rest of your codes on one sheet

Your codes at your locality, with payer contracts beside Medicare.

Build my fee sheet