Billing code 42104: Palatal excisionMedicare rate & RVUs
Report this service when a clinician excises a lesion of the palate or uvula without closing the resulting site.
Medicare pays $218.44 for 42104 nationally in the office and $122.58 in a hospital or facility. Local office rates run $192.88–$290.04.
Medicare rate · 42104
Palatal excision
Swap in your local Medicare rate.
- Work RVUs
- 1.65
- Total RVUs
- 6.54
- Global days
- 010
National rate · 2026
$218.44
Office setting, before claim adjustments.
See every locality for 42104 → · Billed by an NP, PA or therapist? →
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
On this page 10 sections
What 42104 covers
A surgeon removes a lesion from the roof of the mouth or uvula without closing the excision site. The service may be performed by an otolaryngologist or oral and maxillofacial surgeon in an office, ambulatory surgery center, or hospital. It represents removal of the lesion, rather than sampling tissue solely to establish a diagnosis or destroying the lesion in place.
Select this code when the operative report supports excision without closure; document the lesion’s location and the work performed. A 10-day global period includes related postoperative visits during that period. 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. Modifier 50 is inappropriate for this code. Medicare does not pay an assistant at surgery, and 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.
Where 42104 pays more and less
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
109 payment localities
$192.88 to $290.04
109 of 109 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Alabama | $195.75 | $111.88 |
| Alaska* | $252.84 | $150.75 |
| Arizona | $212.55 | $119.66 |
| Arkansas | $192.88 | $110.54 |
| Atlanta | $222.58 | $125.19 |
| Austin | $226.76 | $125.34 |
| Bakersfield | $231.59 | $126.53 |
| Baltimore/Surr. Cntys | $232.45 | $129.59 |
| Beaumont | $203.88 | $116.65 |
| Brazoria | $215.86 | $120.86 |
| Chicago | $229.12 | $132.78 |
| Chico | $230.94 | $125.88 |
| Colorado | $227.48 | $125.48 |
| Connecticut | $233.10 | $129.86 |
| Dallas | $217.27 | $121.79 |
| Dc + Md/Va Suburbs | $250.01 | $137.09 |
| Delaware | $216.10 | $121.39 |
| Detroit | $218.02 | $125.52 |
| East St. Louis | $213.41 | $125.22 |
| El Centro | $230.98 | $125.92 |
| Fort Lauderdale | $226.41 | $129.30 |
| Fort Worth | $215.81 | $121.29 |
| Fresno | $230.94 | $125.88 |
| Galveston | $216.53 | $121.34 |
| Hanford-Corcoran | $230.94 | $125.88 |
| Hawaii, Guam | $236.72 | $127.72 |
| Houston | $220.55 | $125.36 |
| Idaho | $202.09 | $113.90 |
| Indiana | $203.28 | $114.42 |
| Iowa | $200.75 | $113.04 |
| Kansas | $199.82 | $113.16 |
| Kentucky | $200.50 | $115.28 |
| Los Angeles-Long Beach-Anaheim (Los Angeles/Orange Cnty) | $246.78 | $133.37 |
| Madera | $230.94 | $125.88 |
| Manhattan | $251.54 | $140.15 |
| Merced | $230.94 | $125.88 |
| Metropolitan Boston | $250.15 | $135.70 |
| Metropolitan Kansas City | $208.76 | $118.74 |
| Metropolitan Philadelphia | $227.25 | $127.46 |
| Metropolitan St. Louis | $210.97 | $119.71 |
| Miami | $236.07 | $136.28 |
| Minnesota | $217.79 | $119.15 |
| Mississippi | $194.84 | $112.31 |
| Modesto | $230.94 | $125.88 |
| Montana** | $218.43 | $122.57 |
| Napa | $267.90 | $141.56 |
| Nebraska | $201.86 | $113.38 |
| Nevada** | $217.37 | $121.41 |
| New Hampshire | $223.92 | $124.13 |
| New Mexico | $206.97 | $119.07 |
| New Orleans | $210.24 | $120.03 |
| North Carolina | $205.34 | $115.90 |
| North Dakota** | $214.08 | $118.22 |
| Northern Nj | $247.37 | $136.17 |
| Nyc Suburbs/Long Island | $257.75 | $143.77 |
| Ohio | $204.93 | $117.41 |
| Oklahoma | $200.11 | $114.51 |
| Oxnard-Thousand Oaks-Ventura | $245.60 | $132.30 |
| Portland | $234.76 | $128.26 |
| Poughkpsie/N Nyc Suburbs | $237.28 | $132.32 |
| Puerto Rico | $220.05 | $123.13 |
| Queens | $253.61 | $140.30 |
| Redding | $230.94 | $125.88 |
| Rest Of California | $230.94 | $125.88 |
| Rest Of Florida | $215.27 | $123.63 |
| Rest Of Georgia | $203.01 | $117.50 |
| Rest Of Illinois | $209.01 | $121.49 |
| Rest Of Louisiana | $200.20 | $115.36 |
| Rest Of Maine | $203.19 | $114.99 |
| Rest Of Maryland | $220.26 | $123.25 |
| Rest Of Massachusetts | $226.10 | $125.16 |
| Rest Of Michigan | $205.82 | $118.30 |
| Rest Of Missouri | $196.73 | $114.09 |
| Rest Of New Jersey | $235.71 | $131.03 |
| Rest Of New York | $208.46 | $117.39 |
| Rest Of Oregon | $215.64 | $120.16 |
| Rest Of Pennsylvania | $205.25 | $117.25 |
| Rest Of Texas | $209.77 | $118.80 |
| Rest Of Washington | $225.67 | $124.73 |
| Rhode Island | $223.84 | $124.82 |
| Riverside-San Bernardino-Ontario | $233.33 | $128.26 |
| Sacramento-Roseville-Folsom | $242.44 | $130.96 |
| Salinas | $241.54 | $130.44 |
| San Diego-Chula Vista-Carlsbad | $247.30 | $132.65 |
| San Francisco-Oakland-Berkeley (Marin Cnty) | $283.65 | $148.49 |
| San Francisco-Oakland-Berkeley (San Francisco/San Mateo/Alameda/Contra Costa Cnty) | $283.40 | $148.24 |
| San Jose-Sunnyvale-Santa Clara (San Benito Cnty) | $290.04 | $151.81 |
| San Jose-Sunnyvale-Santa Clara (Santa Clara Cnty) | $289.02 | $150.79 |
| San Luis Obispo-Paso Robles | $237.65 | $128.47 |
| Santa Cruz-Watsonville | $249.73 | $133.26 |
| Santa Maria-Santa Barbara | $242.47 | $130.70 |
| Santa Rosa-Petaluma | $252.25 | $134.53 |
| Seattle (King Cnty) | $255.26 | $137.64 |
| South Carolina | $205.49 | $116.91 |
| South Dakota** | $213.56 | $117.70 |
| Southern Maine | $214.33 | $119.33 |
| Stockton | $230.94 | $125.88 |
| Suburban Chicago | $228.71 | $130.26 |
| Tennessee | $200.85 | $113.71 |
| Utah | $208.33 | $118.22 |
| Vallejo | $267.54 | $141.20 |
| Vermont | $213.25 | $118.35 |
| Virgin Islands | $220.05 | $123.13 |
| Virginia | $213.63 | $119.40 |
| Visalia | $230.94 | $125.88 |
| West Virginia | $201.18 | $117.87 |
| Wisconsin | $206.81 | $114.97 |
| Wyoming** | $216.53 | $120.67 |
| Yuba City | $230.94 | $125.88 |
42104 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.
$192.88
$260.49
Color shows the midpoint of each state’s locality range.
View every state and territory as a table
| State / territory | Office rate range | Localities |
|---|---|---|
| AK | $252.84 | 1 |
| AL | $195.75 | 1 |
| AR | $192.88 | 1 |
| AZ | $212.55 | 1 |
| CA | $230.94–$290.04 | 29 |
| CO | $227.48 | 1 |
| CT | $233.10 | 1 |
| DC | $250.01 | 1 |
| DE | $216.10 | 1 |
| FL | $215.27–$236.07 | 3 |
| GA | $203.01–$222.58 | 2 |
| GU | $236.72 | 1 |
| HI | $236.72 | 1 |
| IA | $200.75 | 1 |
| ID | $202.09 | 1 |
| IL | $209.01–$229.12 | 4 |
| IN | $203.28 | 1 |
| KS | $199.82 | 1 |
| KY | $200.50 | 1 |
| LA | $200.20–$210.24 | 2 |
| MA | $226.10–$250.15 | 2 |
| MD | $220.26–$250.01 | 3 |
| ME | $203.19–$214.33 | 2 |
| MI | $205.82–$218.02 | 2 |
| MN | $217.79 | 1 |
| MO | $196.73–$210.97 | 3 |
| MS | $194.84 | 1 |
| MT | $218.43 | 1 |
| NC | $205.34 | 1 |
| ND | $214.08 | 1 |
| NE | $201.86 | 1 |
| NH | $223.92 | 1 |
| NJ | $235.71–$247.37 | 2 |
| NM | $206.97 | 1 |
| NV | $217.37 | 1 |
| NY | $208.46–$257.75 | 5 |
| OH | $204.93 | 1 |
| OK | $200.11 | 1 |
| OR | $215.64–$234.76 | 2 |
| PA | $205.25–$227.25 | 2 |
| PR | $220.05 | 1 |
| RI | $223.84 | 1 |
| SC | $205.49 | 1 |
| SD | $213.56 | 1 |
| TN | $200.85 | 1 |
| TX | $203.88–$226.76 | 8 |
| UT | $208.33 | 1 |
| VA | $213.63–$250.01 | 2 |
| VI | $220.05 | 1 |
| VT | $213.25 | 1 |
| WA | $225.67–$255.26 | 2 |
| WI | $206.81 | 1 |
| WV | $201.18 | 1 |
| WY | $216.53 | 1 |
How the 42104 rate is calculated
Each of 42104’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 · 42104
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 1.65Practice expense 4.67Malpractice 0.22
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 42104
42104 has a 10-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 42104
Palatal excision
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 010 | Minor procedure: the day of the procedure plus 10 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) | 1 | Not paid (statutory restriction). |
| 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) | 0.10/0.80/0.10 | Share of the payment for pre-op, the procedure itself, and post-op care. |
Global surgery period · 42104
Palatal excision
10-day global period ends
Oct 11, 2026
Covers Oct 1, 2026 through Oct 11, 2026 (11 days).
Visit on Oct 31, 2026
After the global period ends: visits and procedures are billed normally.
What modifiers do to the payment
Modifier 51 · payment effect
With and without the modifier
42104 without 51 · national office
$218.44
Palatal excision
42104-51 · Second procedure: 50%
$109.22
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%).
42104 compared with similar codes
Compare codes
42104 vs 42100 vs 42106 vs 42107 vs 42160: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 42100Palate biopsy
- 42100 is for diagnostic biopsy. 42104 is for excision of the lesion without closure.
- 42106Palate excision
- 42106 includes simple repair after excision; 42104 is for excision without closure.
- 42107Palatal lesion excision
- 42107 includes extensive repair after excision; 42104 describes excision without closure.
- 42160Palate lesion treatment
- 42160 treats a lesion by destruction. 42104 removes the lesion by excision.
42104 billing questions
How is this different from 42100?
42100 is for biopsy of the palate or uvula. Use 42104 when the clinician excises the lesion rather than taking tissue only for diagnostic sampling.
When should 42106 or 42107 be considered instead?
These are same-family codes for lesion excision with repair. Choose according to whether the operative documentation supports simple or extensive repair; 42104 describes excision without closure.
Are related postoperative visits separately reported?
Related postoperative visits during the 10-day global period are included in the procedure.
Can modifier 50 be used for lesions on both sides?
No. The CMS bilateral adjustment does not apply, and modifier 50 is inappropriate for this code.
How are other procedures in the same session paid?
The highest-valued procedure is paid in full, and other procedures in the session are subject to the standard multiple-procedure reduction.
Can an assistant or co-surgeon be billed?
Medicare does not pay an assistant at surgery for this service. 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 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
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