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CMS RVU26D · Effective 2026-10-01

42280 in Austin

Office / nonfacility

$191.61

Base rate per service

Facility setting

$99.73

Base rate per service

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.

Palatal prosthetic care

About 42280: Custom palate mold preparation

Preparation of a custom palate mold for prosthetic management of a palatal defect, reported for mold preparation rather than prosthesis insertion.

This service prepares a custom mold shaped to the patient’s palate for prosthetic care of a palatal defect, such as one associated with a cleft. The mold is used in planning or making a palate prosthesis; this code describes preparation, not placement of the finished prosthesis. It is most relevant to care involving a prosthodontist or another clinician experienced in palatal prosthetics, often in an office setting.

Report the service when the record supports preparation of the patient-specific palate mold, rather than a palatal reconstruction or insertion of a prosthesis. Documentation should identify the defect being managed and the mold-preparation work performed. CMS assigns a 10-day global period, so related postoperative visits during that period are included. 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. Assistant-at-surgery payment requires documented medical necessity; co-surgeons and team surgery are not permitted.

CMS billing rules for 42280

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
Assistant at surgery is paid only with documentation of medical necessity.
Co-surgeons
Co-surgeons not permitted.
Team surgery
Team surgery not permitted.

Where the value comes from

  • Work RVU1.55 · 28%
  • Practice expense (office) RVU3.77 · 68%
  • Malpractice RVU0.22 · 4%

24

Medicare services in 2024 · #5813 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.

42280 compared with similar codes

Office rates for Austin, from the same CMS release.

42281

Palate prosthesis

Prosthesis insertion

$250.33

42280 covers preparing the palate mold. Use 42281 for insertion of a palate prosthesis.

42200

Cleft palate repair

Soft and/or hard palate

No office rate

42200 describes surgical cleft-palate reconstruction. 42280 is for mold preparation in prosthetic care, not operative repair.

42210

Cleft palate repair

Alveolar ridge bone graft

No office rate

42210 is a palatal reconstruction procedure. Choose 42280 when the service is preparation of a custom palate mold rather than reconstruction.

The same code, a different location

How does Austin compare?

In Beaumont, the office rate for 42280 is $173.19—$18.42 lower than the $191.61 rate in Austin. Both use the same code, release and participation basis.

42280 across payment areas

Same release and payment basis · bars start at $0

  1. Austin · This locality

    $191.61

  2. Beaumont

    $173.19

    $18.42 lower than Austin

  3. Brazoria

    $182.71

    $8.90 lower than Austin

  4. Dallas

    $183.96

    $7.65 lower than Austin

  5. Fort Worth

    $182.80

    $8.81 lower than Austin

  6. Galveston

    $183.31

    $8.30 lower than Austin

  7. Houston

    $187.34

    $4.27 lower than Austin

Other payment areas listed in Texas appear first, followed by selected cross-country examples. The chart compares amounts, not distance.

Across 109 of 109 CMS payment localities with a supported office rate, 42280 ranges from $163.72 in Arkansas to $242.98 in San Jose-Sunnyvale-Santa Clara (San Benito Cnty). This is a geographic range, not an average.

The code’s RVUs stay the same in these comparisons. Geographic adjustments to work, practice expense and malpractice change the dollar amount. A city name alone may not identify the payment area for a service address.

Compare all 108 other payment areas

  • Rest Of Texas

    Texas · 42280

    Office

    $177.91

    Facility

    $95.49

    $13.70 lower than Austin for the office setting.

  • Los Angeles-Long Beach-Anaheim (Los Angeles/Orange Cnty)

    California · 42280

    Office

    $207.74

    Facility

    $105.00

    $16.13 higher than Austin for the office setting.

  • Dc + Md/Va Suburbs

    District of Columbia · 42280

    Office

    $211.08

    Facility

    $108.78

    $19.47 higher than Austin for the office setting.

  • Miami

    Florida · 42280

    Office

    $201.44

    Facility

    $111.04

    $9.83 higher than Austin for the office setting.

  • Chicago

    Illinois · 42280

    Office

    $195.55

    Facility

    $108.27

    $3.94 higher than Austin for the office setting.

  • Manhattan

    New York · 42280

    Office

    $213.06

    Facility

    $112.15

    $21.45 higher than Austin for the office setting.

  • Alaska*

    Alaska · 42280

    Office

    $215.81

    Facility

    $123.33

    $24.20 higher than Austin for the office setting.

  • Alabama

    Alabama · 42280

    Office

    $166.11

    Facility

    $90.12

    $25.50 lower than Austin for the office setting.

  • Arkansas

    Arkansas · 42280

    Office

    $163.72

    Facility

    $89.12

    $27.89 lower than Austin for the office setting.

  • Arizona

    Arizona · 42280

    Office

    $180.08

    Facility

    $95.93

    $11.53 lower than Austin for the office setting.

  • Bakersfield

    California · 42280

    Office

    $195.24

    Facility

    $100.06

    $3.63 higher than Austin for the office setting.

  • Chico

    California · 42280

    Office

    $194.60

    Facility

    $99.42

    $2.99 higher than Austin for the office setting.

  • El Centro

    California · 42280

    Office

    $194.64

    Facility

    $99.46

    $3.03 higher than Austin for the office setting.

  • Fresno

    California · 42280

    Office

    $194.60

    Facility

    $99.42

    $2.99 higher than Austin for the office setting.

  • Hanford-Corcoran

    California · 42280

    Office

    $194.60

    Facility

    $99.42

    $2.99 higher than Austin for the office setting.

  • Madera

    California · 42280

    Office

    $194.60

    Facility

    $99.42

    $2.99 higher than Austin for the office setting.

  • Merced

    California · 42280

    Office

    $194.60

    Facility

    $99.42

    $2.99 higher than Austin for the office setting.

  • Modesto

    California · 42280

    Office

    $194.60

    Facility

    $99.42

    $2.99 higher than Austin for the office setting.

  • Napa

    California · 42280

    Office

    $224.73

    Facility

    $110.27

    $33.12 higher than Austin for the office setting.

  • Oxnard-Thousand Oaks-Ventura

    California · 42280

    Office

    $206.64

    Facility

    $103.99

    $15.03 higher than Austin for the office setting.

  • Redding

    California · 42280

    Office

    $194.60

    Facility

    $99.42

    $2.99 higher than Austin for the office setting.

  • Rest Of California

    California · 42280

    Office

    $194.60

    Facility

    $99.42

    $2.99 higher than Austin for the office setting.

  • Riverside-San Bernardino-Ontario

    California · 42280

    Office

    $196.98

    Facility

    $101.80

    $5.37 higher than Austin for the office setting.

  • Sacramento-Roseville-Folsom

    California · 42280

    Office

    $204.02

    Facility

    $103.02

    $12.41 higher than Austin for the office setting.

  • Salinas

    California · 42280

    Office

    $203.26

    Facility

    $102.61

    $11.65 higher than Austin for the office setting.

  • San Diego-Chula Vista-Carlsbad

    California · 42280

    Office

    $207.91

    Facility

    $104.05

    $16.30 higher than Austin for the office setting.

  • San Francisco-Oakland-Berkeley (Marin Cnty)

    California · 42280

    Office

    $237.61

    Facility

    $115.16

    $46.00 higher than Austin for the office setting.

  • San Francisco-Oakland-Berkeley (San Francisco/San Mateo/Alameda/Contra Costa Cnty)

    California · 42280

    Office

    $237.36

    Facility

    $114.91

    $45.75 higher than Austin for the office setting.

  • San Jose-Sunnyvale-Santa Clara (San Benito Cnty)

    California · 42280

    Office

    $242.98

    Facility

    $117.76

    $51.37 higher than Austin for the office setting.

  • San Jose-Sunnyvale-Santa Clara (Santa Clara Cnty)

    California · 42280

    Office

    $241.96

    Facility

    $116.74

    $50.35 higher than Austin for the office setting.

  • San Luis Obispo-Paso Robles

    California · 42280

    Office

    $200.01

    Facility

    $101.10

    $8.40 higher than Austin for the office setting.

  • Santa Cruz-Watsonville

    California · 42280

    Office

    $209.79

    Facility

    $104.28

    $18.18 higher than Austin for the office setting.

  • Santa Maria-Santa Barbara

    California · 42280

    Office

    $203.98

    Facility

    $102.73

    $12.37 higher than Austin for the office setting.

  • Santa Rosa-Petaluma

    California · 42280

    Office

    $211.89

    Facility

    $105.25

    $20.28 higher than Austin for the office setting.

  • Stockton

    California · 42280

    Office

    $194.60

    Facility

    $99.42

    $2.99 higher than Austin for the office setting.

  • Vallejo

    California · 42280

    Office

    $224.37

    Facility

    $109.91

    $32.76 higher than Austin for the office setting.

  • Visalia

    California · 42280

    Office

    $194.60

    Facility

    $99.42

    $2.99 higher than Austin for the office setting.

  • Yuba City

    California · 42280

    Office

    $194.60

    Facility

    $99.42

    $2.99 higher than Austin for the office setting.

  • Colorado

    Colorado · 42280

    Office

    $192.11

    Facility

    $99.71

    $0.50 higher than Austin for the office setting.

  • Connecticut

    Connecticut · 42280

    Office

    $197.32

    Facility

    $103.79

    $5.71 higher than Austin for the office setting.

  • Delaware

    Delaware · 42280

    Office

    $183.05

    Facility

    $97.25

    $8.56 lower than Austin for the office setting.

  • Fort Lauderdale

    Florida · 42280

    Office

    $192.62

    Facility

    $104.64

    $1.01 higher than Austin for the office setting.

  • Rest Of Florida

    Florida · 42280

    Office

    $183.20

    Facility

    $100.18

    $8.41 lower than Austin for the office setting.

  • Atlanta

    Georgia · 42280

    Office

    $188.69

    Facility

    $100.46

    $2.92 lower than Austin for the office setting.

  • Rest Of Georgia

    Georgia · 42280

    Office

    $172.85

    Facility

    $95.39

    $18.76 lower than Austin for the office setting.

  • Hawaii, Guam

    Hawaii · 42280

    Office

    $199.20

    Facility

    $100.46

    $7.59 higher than Austin for the office setting.

  • Iowa

    Iowa · 42280

    Office

    $169.91

    Facility

    $90.45

    $21.70 lower than Austin for the office setting.

  • Idaho

    Idaho · 42280

    Office

    $171.09

    Facility

    $91.20

    $20.52 lower than Austin for the office setting.

  • East St. Louis

    Illinois · 42280

    Office

    $182.42

    Facility

    $102.52

    $9.19 lower than Austin for the office setting.

  • Rest Of Illinois

    Illinois · 42280

    Office

    $178.22

    Facility

    $98.94

    $13.39 lower than Austin for the office setting.

  • Suburban Chicago

    Illinois · 42280

    Office

    $194.48

    Facility

    $105.29

    $2.87 higher than Austin for the office setting.

  • Indiana

    Indiana · 42280

    Office

    $172.07

    Facility

    $91.57

    $19.54 lower than Austin for the office setting.

  • Kansas

    Kansas · 42280

    Office

    $169.31

    Facility

    $90.80

    $22.30 lower than Austin for the office setting.

  • Kentucky

    Kentucky · 42280

    Office

    $170.44

    Facility

    $93.24

    $21.17 lower than Austin for the office setting.

  • New Orleans

    Louisiana · 42280

    Office

    $178.61

    Facility

    $96.89

    $13.00 lower than Austin for the office setting.

  • Rest Of Louisiana

    Louisiana · 42280

    Office

    $170.25

    Facility

    $93.40

    $21.36 lower than Austin for the office setting.

  • Metropolitan Boston

    Massachusetts · 42280

    Office

    $210.78

    Facility

    $107.09

    $19.17 higher than Austin for the office setting.

  • Rest Of Massachusetts

    Massachusetts · 42280

    Office

    $191.05

    Facility

    $99.61

    $0.56 lower than Austin for the office setting.

  • Baltimore/Surr. Cntys

    Maryland · 42280

    Office

    $196.80

    Facility

    $103.62

    $5.19 higher than Austin for the office setting.

  • Rest Of Maryland

    Maryland · 42280

    Office

    $186.47

    Facility

    $98.58

    $5.14 lower than Austin for the office setting.

  • Rest Of Maine

    Maine · 42280

    Office

    $172.19

    Facility

    $92.29

    $19.42 lower than Austin for the office setting.

  • Southern Maine

    Maine · 42280

    Office

    $181.20

    Facility

    $95.14

    $10.41 lower than Austin for the office setting.

  • Detroit

    Michigan · 42280

    Office

    $185.67

    Facility

    $101.87

    $5.94 lower than Austin for the office setting.

  • Rest Of Michigan

    Michigan · 42280

    Office

    $175.03

    Facility

    $95.75

    $16.58 lower than Austin for the office setting.

  • Minnesota

    Minnesota · 42280

    Office

    $183.52

    Facility

    $94.16

    $8.09 lower than Austin for the office setting.

  • Metropolitan Kansas City

    Missouri · 42280

    Office

    $177.19

    Facility

    $95.65

    $14.42 lower than Austin for the office setting.

  • Metropolitan St. Louis

    Missouri · 42280

    Office

    $179.01

    Facility

    $96.34

    $12.60 lower than Austin for the office setting.

  • Rest Of Missouri

    Missouri · 42280

    Office

    $167.47

    Facility

    $92.61

    $24.14 lower than Austin for the office setting.

  • Mississippi

    Mississippi · 42280

    Office

    $165.62

    Facility

    $90.85

    $25.99 lower than Austin for the office setting.

  • Montana**

    Montana · 42280

    Office

    $185.03

    Facility

    $98.18

    $6.58 lower than Austin for the office setting.

  • North Carolina

    North Carolina · 42280

    Office

    $173.95

    Facility

    $92.93

    $17.66 lower than Austin for the office setting.

  • North Dakota**

    North Dakota · 42280

    Office

    $180.68

    Facility

    $93.83

    $10.93 lower than Austin for the office setting.

  • Nebraska

    Nebraska · 42280

    Office

    $170.77

    Facility

    $90.62

    $20.84 lower than Austin for the office setting.

  • New Hampshire

    New Hampshire · 42280

    Office

    $189.29

    Facility

    $98.88

    $2.32 lower than Austin for the office setting.

  • Northern Nj

    New Jersey · 42280

    Office

    $208.95

    Facility

    $108.21

    $17.34 higher than Austin for the office setting.

  • Rest Of New Jersey

    New Jersey · 42280

    Office

    $199.41

    Facility

    $104.58

    $7.80 higher than Austin for the office setting.

  • New Mexico

    New Mexico · 42280

    Office

    $176.07

    Facility

    $96.43

    $15.54 lower than Austin for the office setting.

  • Nevada**

    Nevada · 42280

    Office

    $183.94

    Facility

    $97.01

    $7.67 lower than Austin for the office setting.

  • Nyc Suburbs/Long Island

    New York · 42280

    Office

    $218.45

    Facility

    $115.20

    $26.84 higher than Austin for the office setting.

  • Poughkpsie/N Nyc Suburbs

    New York · 42280

    Office

    $200.88

    Facility

    $105.78

    $9.27 higher than Austin for the office setting.

  • Queens

    New York · 42280

    Office

    $214.52

    Facility

    $111.87

    $22.91 higher than Austin for the office setting.

  • Rest Of New York

    New York · 42280

    Office

    $176.56

    Facility

    $94.06

    $15.05 lower than Austin for the office setting.

  • Ohio

    Ohio · 42280

    Office

    $174.14

    Facility

    $94.86

    $17.47 lower than Austin for the office setting.

  • Oklahoma

    Oklahoma · 42280

    Office

    $169.93

    Facility

    $92.38

    $21.68 lower than Austin for the office setting.

  • Portland

    Oregon · 42280

    Office

    $197.97

    Facility

    $101.48

    $6.36 higher than Austin for the office setting.

  • Rest Of Oregon

    Oregon · 42280

    Office

    $182.35

    Facility

    $95.86

    $9.26 lower than Austin for the office setting.

  • Metropolitan Philadelphia

    Pennsylvania · 42280

    Office

    $192.55

    Facility

    $102.15

    $0.94 higher than Austin for the office setting.

  • Rest Of Pennsylvania

    Pennsylvania · 42280

    Office

    $174.31

    Facility

    $94.59

    $17.30 lower than Austin for the office setting.

  • Puerto Rico

    Puerto Rico · 42280

    Office

    $186.32

    Facility

    $98.52

    $5.29 lower than Austin for the office setting.

  • Rhode Island

    Rhode Island · 42280

    Office

    $189.39

    Facility

    $99.68

    $2.22 lower than Austin for the office setting.

  • South Carolina

    South Carolina · 42280

    Office

    $174.37

    Facility

    $94.13

    $17.24 lower than Austin for the office setting.

  • South Dakota**

    South Dakota · 42280

    Office

    $180.16

    Facility

    $93.32

    $11.45 lower than Austin for the office setting.

  • Tennessee

    Tennessee · 42280

    Office

    $170.18

    Facility

    $91.24

    $21.43 lower than Austin for the office setting.

  • Utah

    Utah · 42280

    Office

    $176.74

    Facility

    $95.10

    $14.87 lower than Austin for the office setting.

  • Virginia

    Virginia · 42280

    Office

    $180.74

    Facility

    $95.37

    $10.87 lower than Austin for the office setting.

  • Virgin Islands

    United States Virgin Islands · 42280

    Office

    $186.32

    Facility

    $98.52

    $5.29 lower than Austin for the office setting.

  • Vermont

    Vermont · 42280

    Office

    $180.15

    Facility

    $94.18

    $11.46 lower than Austin for the office setting.

  • Rest Of Washington

    Washington · 42280

    Office

    $190.63

    Facility

    $99.19

    $0.98 lower than Austin for the office setting.

  • Seattle (King Cnty)

    Washington · 42280

    Office

    $214.87

    Facility

    $108.31

    $23.26 higher than Austin for the office setting.

  • Wisconsin

    Wisconsin · 42280

    Office

    $174.67

    Facility

    $91.47

    $16.94 lower than Austin for the office setting.

  • West Virginia

    West Virginia · 42280

    Office

    $171.71

    Facility

    $96.25

    $19.90 lower than Austin for the office setting.

  • Wyoming**

    Wyoming · 42280

    Office

    $183.13

    Facility

    $96.29

    $8.48 lower than Austin for the office setting.

See how rates vary across the country

42280 · Office / nonfacility · Non-QP. Choose a state to explore its payment localities. A range means the amount varies within that state.

MEWIVTNHMTNDMNMINYMARIWAIDWYSDIAILINOHPANJCTORNVUTCONEMOKYWVVAMDDECAAZNMKSOKARTNNCSCDCTXLAMSALGAFLAKHI

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.

$163.72

$218.79

Color shows the midpoint of each state’s locality range.

View all state and territory rates as a table
State / territoryRate rangeLocalities
AK$215.811
AL$166.111
AR$163.721
AZ$180.081
CA$194.60–$242.9829
CO$192.111
CT$197.321
DC$211.081
DE$183.051
FL$183.20–$201.443
GA$172.85–$188.692
GU$199.201
HI$199.201
IA$169.911
ID$171.091
IL$178.22–$195.554
IN$172.071
KS$169.311
KY$170.441
LA$170.25–$178.612
MA$191.05–$210.782
MD$186.47–$211.083
ME$172.19–$181.202
MI$175.03–$185.672
MN$183.521
MO$167.47–$179.013
MS$165.621
MT$185.031
NC$173.951
ND$180.681
NE$170.771
NH$189.291
NJ$199.41–$208.952
NM$176.071
NV$183.941
NY$176.56–$218.455
OH$174.141
OK$169.931
OR$182.35–$197.972
PA$174.31–$192.552
PR$186.321
RI$189.391
SC$174.371
SD$180.161
TN$170.181
TX$173.19–$191.618
UT$176.741
VA$180.74–$211.082
VI$186.321
VT$180.151
WA$190.63–$214.872
WI$174.671
WV$171.711
WY$183.131

Explore 42280 on the national rate map →

Where does this rate apply?

Austin is a Medicare payment area. Our Census mapping connects it to 31 cities and communities in Texas, including the examples shown here.

Some communities span more than one payment area. Follow a city link to compare all of its mapped areas, or check the service-location ZIP above for an address-level starting point.

Browse all communities in Texas →

Why are the office and facility amounts different?

For 42280 in Austin, the physician’s office rate is $191.61 and the facility-setting rate is $99.73: a difference of $91.88.

The calculation uses a different practice-expense RVU for each setting. Both amounts here are physician fee-schedule amounts. The facility figure does not include a hospital’s separate charges, so this comparison does not tell you the total cost of receiving care in each setting.

See the inputs behind this difference →

Use this rate

What is a percentage of Medicare worth?

Turn a percentage into dollars for 42280 in Austin. This uses the base rate on this page, so the locality and release stay consistent.

Reference amount per service

$210.77

$191.61 × 110% = $210.77

A contract may specify another Medicare year or additional adjustments. This is percentage arithmetic on the displayed base rate, not a claim adjudication.

Working with a whole code list?

Compare an offer across your annual code mix, including an older Medicare schedule or flat per-code rates.

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How this local rate is calculated

Each RVU component is multiplied by its own geographic practice cost index (GPCI). The three adjusted components are added, then multiplied by the conversion factor. These are the inputs used for 42280 in Austin.

PPRRVU2026_Oct_nonQPP.csv

5,016

Code
42280
Physician work
1.55
Practice expense
3.77
Malpractice
0.22

GPCI2026.csv

96

Locality
Austin
Physician work
1.002
Practice expense
1.058
Malpractice
0.886
Office / nonfacility calculation for 42280 in Austin
ComponentRVULocality factorAdjusted
Physician work1.55× 1.0021.5531
Practice expense3.77× 1.0583.9887
Malpractice0.22× 0.8860.1949
Total RVUs5.7367
Conversion factor× 33.4009

Office / nonfacility rate, Austin$191.61

Values as parsed from CMS release RVU26D, effective 2026-10-01. The amount is rounded to the nearest cent only at the end.

Open 42280 in the RVU calculator →

Explore RVUs, geographic factors and the full formula

Office / nonfacility

Office / nonfacility calculation inputs
ComponentRVULocal GPCI
Work1.551.002
Practice expense3.771.058
Malpractice0.220.886

(1.55 × 1.002 + 3.77 × 1.058 + 0.22 × 0.886) × $33.4009 = $191.61

Facility

Facility calculation inputs
ComponentRVULocal GPCI
Work1.551.002
Practice expense1.171.058
Malpractice0.220.886

(1.55 × 1.002 + 1.17 × 1.058 + 0.22 × 0.886) × $33.4009 = $99.73

The office and facility calculations use their respective practice-expense RVUs. The facility amount here is the physician fee, not a separate hospital or facility bill.

How this rate has changed

42280 · Office / nonfacility

$191.61

Effective 2026-10-01

The base rate is $16.01 higher than on 2025-10-01, moving from $175.60 to $191.61 (9.1%).

It is unchanged from the immediately preceding available release, effective 2026-07-01.

Base rate by release · bars start at $0 · select a bar to compare

One bar per available release, ordered by effective date. Missing rates remain gaps. These comparisons hold the code, setting and locality identifiers constant; they do not isolate which policy or input caused a change.

What changed, release by release

  1. January 1, 2026

    RVU26A

    $175.60changed to$191.61

    • Conversion factor 32.3465 changed to 33.4009
    • Work RVU 1.59 changed to 1.55
    • Practice expense RVU 3.53 changed to 3.77
    • Malpractice RVU 0.16 changed to 0.22
    • Work GPCI 1.000 changed to 1.002
    • Practice expense GPCI 1.046 changed to 1.058
    • Malpractice GPCI 0.914 changed to 0.886

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    Earliest loaded release: $175.60

    Held through RVU25B, RVU25C, RVU25D.

Explore release dates and calculate this code in an earlier period →

Each row uses the accepted CMS release effective on that date and the same contractor and locality identifiers. Missing rates stay visible. Historical boundaries may differ; verify the service address for an older claim.

Inspect every release and its CMS source
Effective fromOffice / nonfacilityFacilityCMS release
2026-10-01$191.61$99.73RVU26D
2026-07-01$191.61$99.73RVU26C
2026-04-01$191.61$99.73RVU26B
2026-01-01$191.61$99.73RVU26A
2025-10-01$175.60$107.93RVU25D
2025-07-01$175.60$107.93RVU25C
2025-04-01$175.60$107.93RVU25B
2025-01-01$175.60$107.93RVU25A

42280 billing questions

When should this code be used instead of 42281?

Use 42280 for preparation of the custom palate mold. Code 42281 describes insertion of a palate prosthesis, not mold preparation.

Does this code describe a palate repair?

No. It represents mold preparation for prosthetic care; codes such as 42200 describe surgical reconstruction of the palate.

Are related postoperative visits separately reported?

Related postoperative visits during the 10-day global period are included in this service.

Can modifier 50 be appended?

No. CMS identifies bilateral adjustment as inappropriate for this code.

How are other procedures in the same session paid?

The highest-valued procedure is paid in full; other procedures in that session are subject to the standard multiple-procedure reduction.

Can an assistant or co-surgeon be reported?

Assistant-at-surgery payment requires documentation of medical necessity. 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 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.

RVUs for 42280PPRRVU2026_Oct_nonQPP.csv, line 5,016 (RVU26D)
Geographic factors for AustinGPCI2026.csv, line 96 (RVU26D)
Open CMS sourceHow this rate is calculatedBuild a fee sheet