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Billing code 42226: Palate lengtheningMedicare rate & RVUs

Reports surgical palatal lengthening using an island flap, commonly to address a short palate and persistent velopharyngeal dysfunction after cleft-palate repair.

CMS RVU26DEffective Oct 1, 2026109 payment localities

Medicare pays $834.69 for 42226 nationally in a facility.

Medicare rate · 42226

Palate lengthening

Swap in your local Medicare rate.

Work RVUs
10.09
Total RVUs
24.99
Global days
090

National rate · 2026

$834.69

Facility setting, before claim adjustments.

See every locality for 42226 → · 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
  1. Medicare rate
  2. What 42226 covers
  3. By payment locality
  4. Rate map
  5. How it’s calculated
  6. Payment rules
  7. Similar codes
  8. Related codes
  9. Billing questions
  10. Sources

What 42226 covers

This operation lengthens the palate by mobilizing an island flap of tissue while preserving its blood supply, then positioning it to add palatal reach. It may be performed for a short or scarred palate associated with velopharyngeal dysfunction, including in a patient with a history of cleft-palate repair. Plastic surgeons, otolaryngologists, and oral and maxillofacial surgeons with cleft or craniofacial expertise typically perform the procedure in an operating room.

Report 42226 when the operative work uses the island-flap approach; distinguish it from lengthening with a local flap or another secondary palatoplasty technique. The operative report should identify the indication, flap technique, tissue mobilization, and reconstructive work performed. CMS 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 others at 50%. Modifier 50 is inappropriate for this palatal procedure. An assistant at surgery may be paid; 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 42226 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

42226 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$757.31
Alaska*Unavailable$1,010.31
ArizonaUnavailable$813.71
ArkansasUnavailable$747.63
AtlantaUnavailable$852.75
AustinUnavailable$855.78
BakersfieldUnavailable$864.96
Baltimore/Surr. CntysUnavailable$884.46
BeaumontUnavailable$790.83
BrazoriaUnavailable$822.55

42226 rates by state

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

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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
42226 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

How the 42226 rate is calculated

Each of 42226’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 · 42226

RVUs × geographic indexes × conversion factor

Swap in your local Medicare rate.

Work 10.09Practice expense 13.43Malpractice 1.47

24.9900 adjusted RVUs×$33.4009 conversion factor=$834.69

All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.

Payment rules and modifiers for 42226

42226 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 42226

Palate lengthening

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 · 42226

Palate lengthening

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.

  • 24 Unrelated E/M visit by the same physician
  • 79 Unrelated procedure (starts its own global period)
  • 58 Staged, more extensive, or therapy procedure that was planned
  • 78 Unplanned 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

42226 without 51 · national facility

$834.69

Palate lengthening

42226-51 · Second procedure: 50%

$417.35

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

42226 compared with similar codes

Compare codes

42226 vs 42227 vs 42220 vs 42225: national Medicare rates

Swap in your local Medicare rate.

  • 42226
    Palate lengthening · 10.09 wRVU
    —
  • 42227
    Palate lengthening · 9.65 wRVU
    —
  • 42220
    Cleft palate repair · 6.98 wRVU
    —
  • 42225
    Cleft palate repair · 9.53 wRVU
    —

How to choose

42227Palate lengthening
Both codes describe palatal lengthening, but 42226 uses an island flap and 42227 uses a local flap. Use the flap technique documented in the operative report.
42220Cleft palate repair
42220 describes secondary palatoplasty to lengthen the palate. Choose 42226 when the documented lengthening is performed with an island flap.
42225Cleft palate repair
42225 describes secondary palatoplasty lengthening with additional cleft-palate repair work. 42226 identifies lengthening performed with an island flap.

Codes related to 42226

Related codes aren’t interchangeable: bill the code that matches the service performed.

Codes related to 42226
CodeHow it relatesNational office range
Same family
42227Palate lengtheningPalatal lengthening using a local flap rather than the island-flap approach.No office rate
Used instead
42220Cleft palate repairSecondary cleft-palate lengthening by palatoplasty rather than the island-flap method.No office rate
42225Cleft palate repairSecondary palatoplasty lengthening with additional cleft-palate repair work.No office rate

42226 billing questions

How is 42226 distinguished from 42227?

42226 describes palatal lengthening using an island flap. 42227 is the related lengthening procedure using a local flap; the operative report should support the flap method reported.

What documentation supports 42226?

Document the reason for lengthening, the island-flap technique, how the tissue was mobilized and used to lengthen the palate, and relevant prior cleft-palate repair or scarring.

Can modifier 50 be reported?

No. Modifier 50 is inappropriate for this palatal procedure.

How does the 90-day global period affect postoperative reporting?

The global period includes the day-before preoperative visit and 90 days of related postoperative care. Those related services are included in the surgical global package.

How are other same-session procedures paid?

Under the standard multiple procedure reduction, the highest-valued procedure is paid in full and other procedures are paid at 50%. An assistant at surgery may be paid, but co-surgeons and team surgery 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
RVUs for 42226PPRRVU2026_Oct_nonQPP.csv, line 5,012 (RVU26D)

Open CMS sourceHow we calculate rates

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