Billing code 42226: Palate lengtheningMedicare rate & RVUs in Delaware

In Delaware, Medicare pays $826.03 for 42226 in a facility. There’s no office rate.

Check a contract rate as a % of Medicare · 42226 nationwide

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

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.

How Delaware compares for 42226

Across 109 of 109 payment localities, the facility rate for 42226 runs from $747.63 in Arkansas to $1,047.25 in San Jose-Sunnyvale-Santa Clara (San Benito Cnty). Delaware pays $826.03. The RVUs are the same everywhere; the geographic indexes change the dollars.

Every other payment area

42226 rates by state

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

See 42226 in every payment locality

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.

Payment rules and modifiers for 42226

42226 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

Codes related to 42226

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

How 42226 has changed in Delaware

Price 42226 for an earlier date of service

Where the Delaware rate applies

Delaware is a Medicare payment area, not a city. Our Census mapping connects it to 79 cities and communities in Delaware. Some span more than one payment area; confirm with the service ZIP.

• 42226 in Arden
• 42226 in Ardencroft
• 42226 in Ardentown
• 42226 in Bear
• 42226 in Bellefonte
• 42226 in Bethany Beach
• 42226 in Bethel
• 42226 in Blades

Browse all communities in Delaware

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