Billing code 42120: Palate resectionMedicare rate & RVUs

Medicare pays $912.18 for 42120 nationally in a facility.

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

What 42120 covers

An otolaryngologist or oral and maxillofacial surgeon reports this service when surgery removes a substantial portion of the palate or requires extensive excision of a palatal lesion. It is typically performed in an operating room, often for a sizable tumor or other lesion whose extent calls for more than a localized excision. The resected tissue may be submitted for pathologic examination.

Choose this code based on the operative extent and tissue removed, not the lesion diagnosis alone. The operative report should describe the palatal site, lesion extent, amount of tissue resected, and surgical work performed; limited lesion excision belongs to the more specific excision codes when their criteria are met. Medicare assigns a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. For multiple procedures in one session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% reduction. Bilateral adjustment is inappropriate. Assistant-at-surgery payment may be available; co-surgeon payment requires supporting documentation, and team surgery is 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 42120 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

42120 rates by state

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

How the 42120 rate is calculated

Each of 42120’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 42120

42120 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

42120 compared with similar codes

How to choose

42104Palatal excision

42104 is for a more limited lesion excision without closure. Use 42120 when the documented work involves extensive lesion removal or substantial palate resection.

42106Palate excision

42106 describes limited lesion excision with simple repair. It does not represent extensive palate resection.

42107Palatal lesion excision

42107 describes limited lesion excision with complex repair. Distinguish it from 42120 by the extent of tissue resected, not simply by the complexity of closure.

42100Palate biopsy

42100 is for obtaining a palatal biopsy specimen. It is not the code for definitive extensive removal of the palate or a lesion.

Codes related to 42120

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