$192.88–$290.04
42100 describes diagnostic tissue sampling. 42104 is for excision of a palate lesion 1 cm or less.
On this page
CMS RVU26D · Effective 2026-10-01
42100 Palate biopsy Medicare reimbursement rates
Report this service when a clinician takes a tissue sample from the roof of the mouth for evaluation of a suspicious oral lesion. Compare 42100 office and facility rates across CMS payment localities.
Amounts below use the non-QP conversion factor for participating physicians. These are base physician payments before claim-level adjustments, not patient costs or total hospital charges.
What does Medicare pay for 42100?
The service location and office or facility setting determine which base rate applies. These are the supported base rates for the 109 payment areas shown below, using the same CMS release.
Office / nonfacility
$133.02–$196.06
109 of 109 localities have a supported rate.
Lowest: Arkansas
Highest: San Jose-Sunnyvale-Santa Clara (San Benito Cnty)
A spread of $63.04 per service.
Facility setting
$91.42–$126.22
109 of 109 localities have a supported rate.
Lowest: Arkansas
Highest: San Jose-Sunnyvale-Santa Clara (San Benito Cnty)
A spread of $34.80 per service.
These are locality ranges, not averages or address-specific quotes. A facility-setting amount covers the physician service; it does not include a hospital’s separate bill. Choose a locality below to inspect its calculation, compare other payment areas, or price a percentage of Medicare.
Where 42100 pays more and less
109 payment localities
$133.02 to $196.06
Oral surgery
About 42100: Palatal tissue biopsy
Report this service when a clinician takes a tissue sample from the roof of the mouth for evaluation of a suspicious oral lesion.
This service covers taking a tissue sample from the palate, the roof of the mouth, for diagnostic examination. Otolaryngologists and oral and maxillofacial surgeons commonly perform it in an office, procedure room, or operating room when assessing a suspicious ulcer, patch, or mass. The work is sampling tissue for diagnosis, rather than removing a palate lesion as definitive treatment.
Select the code when the documented service is a palatal biopsy; record the sampled site, the finding or concern prompting the procedure, and the tissue submitted. CMS assigns a 10-day minor-procedure global period, so related postoperative visits during that interval are included. If multiple procedures subject to the standard reduction are performed in the same session, the highest-valued procedure is paid in full and the others at 50%. Palatal anatomy makes modifier 50 inappropriate. Medicare does not pay an assistant at surgery, and co-surgeon and team-surgery billing are not permitted.
CMS billing rules for 42100
- Global period
- Minor procedure with a 10-day global period: related postoperative visits for 10 days are included.
- Multiple procedures
- Standard multiple procedure reduction: the highest-valued procedure is paid in full and others at 50% when performed in the same session.
- Bilateral procedures
- Bilateral adjustment does not apply; the descriptor or anatomy makes modifier 50 inappropriate.
- Assistant at surgery
- Statutory restriction: assistant at surgery is not paid.
- Co-surgeons
- Co-surgeons not permitted.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU1.33 · 30%
- Practice expense (office) RVU2.98 · 66%
- Malpractice RVU0.18 · 4%
2.2K
Medicare services in 2024 · #2402 by national volume
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.
42100 compared with similar codes
Office rate ranges across all CMS payment localities, from the same CMS release.
$231.44–$345.67
42100 describes diagnostic tissue sampling. 42106 is for excision of a palate lesion over 1 cm.
$418.44–$611.43
42100 describes diagnostic tissue sampling. 42107 is for extensive excision of a palate lesion.
See how rates vary across the country
42100 · Office / nonfacility · Non-QP. Choose a state to explore its payment localities. A range means the amount varies within that state.
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.
$133.02
$176.78
Color shows the midpoint of each state’s locality range.
View all state and territory rates as a table
| State / territory | Rate range | Localities |
|---|---|---|
| AK | $175.95 | 1 |
| AL | $134.92 | 1 |
| AR | $133.02 | 1 |
| AZ | $146.02 | 1 |
| CA | $157.49–$196.06 | 29 |
| CO | $155.56 | 1 |
| CT | $159.79 | 1 |
| DC | $170.77 | 1 |
| DE | $148.39 | 1 |
| FL | $148.61–$163.24 | 3 |
| GA | $140.37–$152.90 | 2 |
| GU | $161.08 | 1 |
| HI | $161.08 | 1 |
| IA | $137.88 | 1 |
| ID | $138.84 | 1 |
| IL | $144.70–$158.56 | 4 |
| IN | $139.61 | 1 |
| KS | $137.43 | 1 |
| KY | $138.41 | 1 |
| LA | $138.27–$144.92 | 2 |
| MA | $154.74–$170.44 | 2 |
| MD | $151.12–$170.77 | 3 |
| ME | $139.73–$146.86 | 2 |
| MI | $142.09–$150.61 | 2 |
| MN | $148.62 | 1 |
| MO | $136.08–$145.20 | 3 |
| MS | $134.57 | 1 |
| MT | $149.96 | 1 |
| NC | $141.13 | 1 |
| ND | $146.40 | 1 |
| NE | $138.57 | 1 |
| NH | $153.30 | 1 |
| NJ | $161.49–$169.10 | 2 |
| NM | $142.92 | 1 |
| NV | $149.07 | 1 |
| NY | $143.21–$176.78 | 5 |
| OH | $141.36 | 1 |
| OK | $137.98 | 1 |
| OR | $147.79–$160.19 | 2 |
| PA | $141.48–$156.01 | 2 |
| PR | $150.97 | 1 |
| RI | $153.45 | 1 |
| SC | $141.50 | 1 |
| SD | $145.98 | 1 |
| TN | $138.13 | 1 |
| TX | $140.59–$155.15 | 8 |
| UT | $143.38 | 1 |
| VA | $146.51–$170.77 | 2 |
| VI | $150.97 | 1 |
| VT | $146.00 | 1 |
| WA | $154.39–$173.69 | 2 |
| WI | $141.63 | 1 |
| WV | $139.52 | 1 |
| WY | $148.41 | 1 |
Compare 42100 by payment locality
Find the payment area for your service address, then open its rate page for calculation inputs, release history and the percentage-of-Medicare tool. A city may cross payment-area boundaries; the ZIP lookup above helps resolve the location.
109 of 109 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Alabama | Office $134.92 | Facility $92.54 |
| Alaska* | Office $175.95 | Facility $124.37 |
| Arizona | Office $146.02 | Facility $99.09 |
| Arkansas | Office $133.02 | Facility $91.42 |
| Atlanta | Office $152.90 | Facility $103.70 |
| Austin | Office $155.15 | Facility $103.91 |
| Bakersfield | Office $158.02 | Facility $104.94 |
| Baltimore/Surr. Cntys | Office $159.37 | Facility $107.40 |
| Beaumont | Office $140.59 | Facility $96.51 |
| Brazoria | Office $148.11 | Facility $100.11 |
| Chicago | Office $158.56 | Facility $109.89 |
| Chico | Office $157.49 | Facility $104.41 |
| Colorado | Office $155.56 | Facility $104.03 |
| Connecticut | Office $159.79 | Facility $107.62 |
| Dallas | Office $149.12 | Facility $100.88 |
| Dc + Md/Va Suburbs | Office $170.77 | Facility $113.71 |
| Delaware | Office $148.39 | Facility $100.54 |
| Detroit | Office $150.61 | Facility $103.87 |
| East St. Louis | Office $148.10 | Facility $103.55 |
| El Centro | Office $157.52 | Facility $104.44 |
| Fort Lauderdale | Office $156.12 | Facility $107.06 |
| Fort Worth | Office $148.20 | Facility $100.45 |
| Fresno | Office $157.49 | Facility $104.41 |
| Galveston | Office $148.59 | Facility $100.50 |
| Hanford-Corcoran | Office $157.49 | Facility $104.41 |
| Hawaii, Guam | Office $161.08 | Facility $106.01 |
| Houston | Office $151.89 | Facility $103.80 |
| Idaho | Office $138.84 | Facility $94.28 |
| Indiana | Office $139.61 | Facility $94.72 |
| Iowa | Office $137.88 | Facility $93.57 |
| Kansas | Office $137.43 | Facility $93.65 |
| Kentucky | Office $138.41 | Facility $95.36 |
| Los Angeles-Long Beach-Anaheim (Los Angeles/Orange Cnty) | Office $167.99 | Facility $110.69 |
| Madera | Office $157.49 | Facility $104.41 |
| Manhattan | Office $172.46 | Facility $116.18 |
| Merced | Office $157.49 | Facility $104.41 |
| Metropolitan Boston | Office $170.44 | Facility $112.61 |
| Metropolitan Kansas City | Office $143.76 | Facility $98.28 |
| Metropolitan Philadelphia | Office $156.01 | Facility $105.59 |
| Metropolitan St. Louis | Office $145.20 | Facility $99.10 |
| Miami | Office $163.24 | Facility $112.83 |
| Minnesota | Office $148.62 | Facility $98.79 |
| Mississippi | Office $134.57 | Facility $92.87 |
| Modesto | Office $157.49 | Facility $104.41 |
| Montana** | Office $149.96 | Facility $101.53 |
| Napa | Office $181.46 | Facility $117.63 |
| Nebraska | Office $138.57 | Facility $93.86 |
| Nevada** | Office $149.07 | Facility $100.59 |
| New Hampshire | Office $153.30 | Facility $102.88 |
| New Mexico | Office $142.92 | Facility $98.51 |
| New Orleans | Office $144.92 | Facility $99.34 |
| North Carolina | Office $141.13 | Facility $95.94 |
| North Dakota** | Office $146.40 | Facility $97.97 |
| Northern Nj | Office $169.10 | Facility $112.92 |
| Nyc Suburbs/Long Island | Office $176.78 | Facility $119.19 |
| Ohio | Office $141.36 | Facility $97.14 |
| Oklahoma | Office $137.98 | Facility $94.73 |
| Oxnard-Thousand Oaks-Ventura | Office $167.06 | Facility $109.82 |
| Portland | Office $160.19 | Facility $106.38 |
| Poughkpsie/N Nyc Suburbs | Office $162.69 | Facility $109.66 |
| Puerto Rico | Office $150.97 | Facility $102.01 |
| Queens | Office $173.59 | Facility $116.34 |
| Redding | Office $157.49 | Facility $104.41 |
| Rest Of California | Office $157.49 | Facility $104.41 |
| Rest Of Florida | Office $148.61 | Facility $102.31 |
| Rest Of Georgia | Office $140.37 | Facility $97.17 |
| Rest Of Illinois | Office $144.70 | Facility $100.48 |
| Rest Of Louisiana | Office $138.27 | Facility $95.41 |
| Rest Of Maine | Office $139.73 | Facility $95.18 |
| Rest Of Maryland | Office $151.12 | Facility $102.10 |
| Rest Of Massachusetts | Office $154.74 | Facility $103.74 |
| Rest Of Michigan | Office $142.09 | Facility $97.87 |
| Rest Of Missouri | Office $136.08 | Facility $94.33 |
| Rest Of New Jersey | Office $161.49 | Facility $108.60 |
| Rest Of New York | Office $143.21 | Facility $97.20 |
| Rest Of Oregon | Office $147.79 | Facility $99.55 |
| Rest Of Pennsylvania | Office $141.48 | Facility $97.02 |
| Rest Of Texas | Office $144.31 | Facility $98.35 |
| Rest Of Washington | Office $154.39 | Facility $103.39 |
| Rhode Island | Office $153.45 | Facility $103.42 |
| Riverside-San Bernardino-Ontario | Office $159.44 | Facility $106.36 |
| Sacramento-Roseville-Folsom | Office $165.00 | Facility $108.68 |
| Salinas | Office $164.38 | Facility $108.25 |
| San Diego-Chula Vista-Carlsbad | Office $168.06 | Facility $110.13 |
| San Francisco-Oakland-Berkeley (Marin Cnty) | Office $191.75 | Facility $123.46 |
| San Francisco-Oakland-Berkeley (San Francisco/San Mateo/Alameda/Contra Costa Cnty) | Office $191.54 | Facility $123.25 |
| San Jose-Sunnyvale-Santa Clara (San Benito Cnty) | Office $196.06 | Facility $126.22 |
| San Jose-Sunnyvale-Santa Clara (Santa Clara Cnty) | Office $195.23 | Facility $125.39 |
| San Luis Obispo-Paso Robles | Office $161.77 | Facility $106.61 |
| Santa Cruz-Watsonville | Office $169.51 | Facility $110.67 |
| Santa Maria-Santa Barbara | Office $164.95 | Facility $108.48 |
| Santa Rosa-Petaluma | Office $171.21 | Facility $111.73 |
| Seattle (King Cnty) | Office $173.69 | Facility $114.26 |
| South Carolina | Office $141.50 | Facility $96.75 |
| South Dakota** | Office $145.98 | Facility $97.55 |
| Southern Maine | Office $146.86 | Facility $98.86 |
| Stockton | Office $157.49 | Facility $104.41 |
| Suburban Chicago | Office $157.61 | Facility $107.87 |
| Tennessee | Office $138.13 | Facility $94.10 |
| Utah | Office $143.38 | Facility $97.86 |
| Vallejo | Office $181.17 | Facility $117.34 |
| Vermont | Office $146.00 | Facility $98.06 |
| Virgin Islands | Office $150.97 | Facility $102.01 |
| Virginia | Office $146.51 | Facility $98.90 |
| Visalia | Office $157.49 | Facility $104.41 |
| West Virginia | Office $139.52 | Facility $97.44 |
| Wisconsin | Office $141.63 | Facility $95.23 |
| Wyoming** | Office $148.41 | Facility $99.98 |
| Yuba City | Office $157.49 | Facility $104.41 |
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42100 billing questions
When should this code be chosen instead of a palate excision code?
Use this code when the service is tissue sampling for diagnosis. When the procedure removes a palate lesion, consider the applicable excision code instead.
Can modifier 50 be reported for biopsies on both sides of the palate?
No. CMS identifies bilateral adjustment as inappropriate for this code because of the descriptor or anatomy.
Are related postoperative visits separately reported during the global period?
Related postoperative visits during the 10-day global period are included in the procedure.
What documentation supports reporting a palatal biopsy?
Document the palate site sampled, the clinical finding or concern that prompted sampling, and that tissue was obtained for diagnostic evaluation.
Can an assistant surgeon or co-surgeon be billed?
Medicare does not pay an assistant at surgery for this service, and co-surgeon and team-surgery billing are not permitted.
Where these rates come from
FeeBase calculates base physician payments from CMS work, practice-expense, and malpractice RVUs, adjusted by each locality’s geographic indices and the applicable conversion factor. Unavailable or separately priced services are labeled rather than assigned a made-up amount.
Source: RVU26D. Effective 2026-10-01 through the day before 2027-01-01.
4,99042000,,Drainage mouth roof lesion,A,,1.25,3.36,,1.54,,0.18,4.79,2.97,0,010,0.10,0.80,0.10,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,9914200F,,External beam to prost only,I,,0.00,0.00,,0.00,,0.00,0.00,0.00,9,XXX,0.00,0.00,0.00,9,9,9,9,9,9,,33.4009,09,0,99,0.00,0.00,0.00
4,9924201F,,Extrnl beam other than prost,I,,0.00,0.00,,0.00,,0.00,0.00,0.00,9,XXX,0.00,0.00,0.00,9,9,9,9,9,9,,33.4009,09,0,99,0.00,0.00,0.00
4,99342100,,Biopsy roof of mouth,A,,1.33,2.98,,1.53,,0.18,4.49,3.04,0,010,0.10,0.80,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,99442104,,Excision lesion mouth roof,A,,1.65,4.67,,1.80,,0.22,6.54,3.67,0,010,0.10,0.80,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,99542106,,Excision lesion mouth roof,A,,2.10,5.46,,2.12,,0.27,7.83,4.49,0,010,0.10,0.80,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,99642107,,Excision lesion mouth roof,A,,4.45,9.05,,4.08,,0.59,14.09,9.12,0,090,0.09,0.81,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00