Billing code 42106: Palate excisionMedicare rate & RVUs

Medicare pays $261.53 for 42106 nationally in the office and $149.97 in a hospital or facility. Local office rates run $231.44–$345.67.

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

What 42106 covers

This service removes a lesion from the palate or uvula and closes the resulting wound with a simple primary closure. It is typically performed by an otolaryngologist or oral and maxillofacial surgeon in an office or facility setting. The lesion may be submitted for pathologic examination; the code choice follows the operative method of removal and closure, not the eventual pathology result.

Report this code when the surgeon excises the lesion and closes the site directly without a local flap. The operative note should identify the palate or uvula site, describe the excision and closure, and distinguish simple closure from closure using a flap. CMS assigns a 10-day global period, including related postoperative visits during that interval. When other procedures are performed in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard multiple-procedure reduction. Modifier 50 is inappropriate for this code. Medicare does not pay an assistant at surgery for this service; 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 42106 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

42106 rates by state

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

How the 42106 rate is calculated

Each of 42106’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 42106

42106 has a 10-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

42106 compared with similar codes

How to choose

42100Palate biopsy

42100 reports biopsy for diagnostic sampling. Choose 42106 when the lesion is excised and the wound receives a simple primary closure.

42104Palatal excision

42104 applies when the excision site is left without closure; 42106 applies when it is directly closed.

42107Palatal lesion excision

42107 includes closure with a local flap. A simple direct closure after excision supports 42106.

42120Palate resection

42120 concerns palate resection or a more extensive palate lesion procedure. 42106 is for lesion excision with simple primary closure.

Codes related to 42106

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