42100 describes diagnostic tissue sampling. 42104 is for excision of a palate lesion 1 cm or less.
On this page
CMS RVU26D · Effective 2026-10-01
42100 in El Centro
Office / nonfacility
$157.52
Base rate per service
Facility setting
$104.44
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.
Oral surgery
About 42100: Palatal tissue biopsy
Report this service when a clinician takes a tissue sample from the roof of the mouth for evaluation of a suspicious oral lesion.
This service covers taking a tissue sample from the palate, the roof of the mouth, for diagnostic examination. Otolaryngologists and oral and maxillofacial surgeons commonly perform it in an office, procedure room, or operating room when assessing a suspicious ulcer, patch, or mass. The work is sampling tissue for diagnosis, rather than removing a palate lesion as definitive treatment.
Select the code when the documented service is a palatal biopsy; record the sampled site, the finding or concern prompting the procedure, and the tissue submitted. CMS assigns a 10-day minor-procedure global period, so related postoperative visits during that interval are included. If multiple procedures subject to the standard reduction are performed in the same session, the highest-valued procedure is paid in full and the others at 50%. Palatal anatomy makes modifier 50 inappropriate. Medicare does not pay an assistant at surgery, and co-surgeon and team-surgery billing are not permitted.
CMS billing rules for 42100
- 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
- Statutory restriction: assistant at surgery is not paid.
- Co-surgeons
- Co-surgeons not permitted.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU1.33 · 30%
- Practice expense (office) RVU2.98 · 66%
- Malpractice RVU0.18 · 4%
2.2K
Medicare services in 2024 · #2402 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.
42100 compared with similar codes
Office rates for El Centro, from the same CMS release.
42100 describes diagnostic tissue sampling. 42106 is for excision of a palate lesion over 1 cm.
42100 describes diagnostic tissue sampling. 42107 is for extensive excision of a palate lesion.
The same code, a different location
How does El Centro compare?
In Bakersfield, the office rate for 42100 is $158.02—$0.50 higher than the $157.52 rate in El Centro. Both use the same code, release and participation basis.
42100 across payment areas
Same release and payment basis · bars start at $0
El Centro · This locality
$157.52
$158.02
$0.50 higher than El Centro
$157.49
$0.03 lower than El Centro
$157.49
$0.03 lower than El Centro
$157.49
$0.03 lower than El Centro
$10.47 higher than El Centro
$157.49
$0.03 lower than El Centro
Other payment areas listed in California 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, 42100 ranges from $133.02 in Arkansas to $196.06 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
Merced
California · 42100
Office
$157.49
Facility
$104.41
$0.03 lower than El Centro for the office setting.
Modesto
California · 42100
Office
$157.49
Facility
$104.41
$0.03 lower than El Centro for the office setting.
Napa
California · 42100
Office
$181.46
Facility
$117.63
$23.94 higher than El Centro for the office setting.
Oxnard-Thousand Oaks-Ventura
California · 42100
Office
$167.06
Facility
$109.82
$9.54 higher than El Centro for the office setting.
Redding
California · 42100
Office
$157.49
Facility
$104.41
$0.03 lower than El Centro for the office setting.
Rest Of California
California · 42100
Office
$157.49
Facility
$104.41
$0.03 lower than El Centro for the office setting.
Riverside-San Bernardino-Ontario
California · 42100
Office
$159.44
Facility
$106.36
$1.92 higher than El Centro for the office setting.
Sacramento-Roseville-Folsom
California · 42100
Office
$165.00
Facility
$108.68
$7.48 higher than El Centro for the office setting.
Salinas
California · 42100
Office
$164.38
Facility
$108.25
$6.86 higher than El Centro for the office setting.
San Diego-Chula Vista-Carlsbad
California · 42100
Office
$168.06
Facility
$110.13
$10.54 higher than El Centro for the office setting.
San Francisco-Oakland-Berkeley (Marin Cnty)
California · 42100
Office
$191.75
Facility
$123.46
$34.23 higher than El Centro for the office setting.
San Francisco-Oakland-Berkeley (San Francisco/San Mateo/Alameda/Contra Costa Cnty)
California · 42100
Office
$191.54
Facility
$123.25
$34.02 higher than El Centro for the office setting.
San Jose-Sunnyvale-Santa Clara (San Benito Cnty)
California · 42100
Office
$196.06
Facility
$126.22
$38.54 higher than El Centro for the office setting.
San Jose-Sunnyvale-Santa Clara (Santa Clara Cnty)
California · 42100
Office
$195.23
Facility
$125.39
$37.71 higher than El Centro for the office setting.
San Luis Obispo-Paso Robles
California · 42100
Office
$161.77
Facility
$106.61
$4.25 higher than El Centro for the office setting.
Santa Cruz-Watsonville
California · 42100
Office
$169.51
Facility
$110.67
$11.99 higher than El Centro for the office setting.
Santa Maria-Santa Barbara
California · 42100
Office
$164.95
Facility
$108.48
$7.43 higher than El Centro for the office setting.
Santa Rosa-Petaluma
California · 42100
Office
$171.21
Facility
$111.73
$13.69 higher than El Centro for the office setting.
Stockton
California · 42100
Office
$157.49
Facility
$104.41
$0.03 lower than El Centro for the office setting.
Vallejo
California · 42100
Office
$181.17
Facility
$117.34
$23.65 higher than El Centro for the office setting.
Visalia
California · 42100
Office
$157.49
Facility
$104.41
$0.03 lower than El Centro for the office setting.
Yuba City
California · 42100
Office
$157.49
Facility
$104.41
$0.03 lower than El Centro for the office setting.
Dc + Md/Va Suburbs
District of Columbia · 42100
Office
$170.77
Facility
$113.71
$13.25 higher than El Centro for the office setting.
Miami
Florida · 42100
Office
$163.24
Facility
$112.83
$5.72 higher than El Centro for the office setting.
Chicago
Illinois · 42100
Office
$158.56
Facility
$109.89
$1.04 higher than El Centro for the office setting.
Manhattan
New York · 42100
Office
$172.46
Facility
$116.18
$14.94 higher than El Centro for the office setting.
Alaska*
Alaska · 42100
Office
$175.95
Facility
$124.37
$18.43 higher than El Centro for the office setting.
Alabama
Alabama · 42100
Office
$134.92
Facility
$92.54
$22.60 lower than El Centro for the office setting.
Arkansas
Arkansas · 42100
Office
$133.02
Facility
$91.42
$24.50 lower than El Centro for the office setting.
Arizona
Arizona · 42100
Office
$146.02
Facility
$99.09
$11.50 lower than El Centro for the office setting.
Colorado
Colorado · 42100
Office
$155.56
Facility
$104.03
$1.96 lower than El Centro for the office setting.
Connecticut
Connecticut · 42100
Office
$159.79
Facility
$107.62
$2.27 higher than El Centro for the office setting.
Delaware
Delaware · 42100
Office
$148.39
Facility
$100.54
$9.13 lower than El Centro for the office setting.
Fort Lauderdale
Florida · 42100
Office
$156.12
Facility
$107.06
$1.40 lower than El Centro for the office setting.
Rest Of Florida
Florida · 42100
Office
$148.61
Facility
$102.31
$8.91 lower than El Centro for the office setting.
Atlanta
Georgia · 42100
Office
$152.90
Facility
$103.70
$4.62 lower than El Centro for the office setting.
Rest Of Georgia
Georgia · 42100
Office
$140.37
Facility
$97.17
$17.15 lower than El Centro for the office setting.
Hawaii, Guam
Hawaii · 42100
Office
$161.08
Facility
$106.01
$3.56 higher than El Centro for the office setting.
Iowa
Iowa · 42100
Office
$137.88
Facility
$93.57
$19.64 lower than El Centro for the office setting.
Idaho
Idaho · 42100
Office
$138.84
Facility
$94.28
$18.68 lower than El Centro for the office setting.
East St. Louis
Illinois · 42100
Office
$148.10
Facility
$103.55
$9.42 lower than El Centro for the office setting.
Rest Of Illinois
Illinois · 42100
Office
$144.70
Facility
$100.48
$12.82 lower than El Centro for the office setting.
Suburban Chicago
Illinois · 42100
Office
$157.61
Facility
$107.87
$0.09 higher than El Centro for the office setting.
Indiana
Indiana · 42100
Office
$139.61
Facility
$94.72
$17.91 lower than El Centro for the office setting.
Kansas
Kansas · 42100
Office
$137.43
Facility
$93.65
$20.09 lower than El Centro for the office setting.
Kentucky
Kentucky · 42100
Office
$138.41
Facility
$95.36
$19.11 lower than El Centro for the office setting.
New Orleans
Louisiana · 42100
Office
$144.92
Facility
$99.34
$12.60 lower than El Centro for the office setting.
Rest Of Louisiana
Louisiana · 42100
Office
$138.27
Facility
$95.41
$19.25 lower than El Centro for the office setting.
Metropolitan Boston
Massachusetts · 42100
Office
$170.44
Facility
$112.61
$12.92 higher than El Centro for the office setting.
Rest Of Massachusetts
Massachusetts · 42100
Office
$154.74
Facility
$103.74
$2.78 lower than El Centro for the office setting.
Baltimore/Surr. Cntys
Maryland · 42100
Office
$159.37
Facility
$107.40
$1.85 higher than El Centro for the office setting.
Rest Of Maryland
Maryland · 42100
Office
$151.12
Facility
$102.10
$6.40 lower than El Centro for the office setting.
Rest Of Maine
Maine · 42100
Office
$139.73
Facility
$95.18
$17.79 lower than El Centro for the office setting.
Southern Maine
Maine · 42100
Office
$146.86
Facility
$98.86
$10.66 lower than El Centro for the office setting.
Detroit
Michigan · 42100
Office
$150.61
Facility
$103.87
$6.91 lower than El Centro for the office setting.
Rest Of Michigan
Michigan · 42100
Office
$142.09
Facility
$97.87
$15.43 lower than El Centro for the office setting.
Minnesota
Minnesota · 42100
Office
$148.62
Facility
$98.79
$8.90 lower than El Centro for the office setting.
Metropolitan Kansas City
Missouri · 42100
Office
$143.76
Facility
$98.28
$13.76 lower than El Centro for the office setting.
Metropolitan St. Louis
Missouri · 42100
Office
$145.20
Facility
$99.10
$12.32 lower than El Centro for the office setting.
Rest Of Missouri
Missouri · 42100
Office
$136.08
Facility
$94.33
$21.44 lower than El Centro for the office setting.
Mississippi
Mississippi · 42100
Office
$134.57
Facility
$92.87
$22.95 lower than El Centro for the office setting.
Montana**
Montana · 42100
Office
$149.96
Facility
$101.53
$7.56 lower than El Centro for the office setting.
North Carolina
North Carolina · 42100
Office
$141.13
Facility
$95.94
$16.39 lower than El Centro for the office setting.
North Dakota**
North Dakota · 42100
Office
$146.40
Facility
$97.97
$11.12 lower than El Centro for the office setting.
Nebraska
Nebraska · 42100
Office
$138.57
Facility
$93.86
$18.95 lower than El Centro for the office setting.
New Hampshire
New Hampshire · 42100
Office
$153.30
Facility
$102.88
$4.22 lower than El Centro for the office setting.
Northern Nj
New Jersey · 42100
Office
$169.10
Facility
$112.92
$11.58 higher than El Centro for the office setting.
Rest Of New Jersey
New Jersey · 42100
Office
$161.49
Facility
$108.60
$3.97 higher than El Centro for the office setting.
New Mexico
New Mexico · 42100
Office
$142.92
Facility
$98.51
$14.60 lower than El Centro for the office setting.
Nevada**
Nevada · 42100
Office
$149.07
Facility
$100.59
$8.45 lower than El Centro for the office setting.
Nyc Suburbs/Long Island
New York · 42100
Office
$176.78
Facility
$119.19
$19.26 higher than El Centro for the office setting.
Poughkpsie/N Nyc Suburbs
New York · 42100
Office
$162.69
Facility
$109.66
$5.17 higher than El Centro for the office setting.
Queens
New York · 42100
Office
$173.59
Facility
$116.34
$16.07 higher than El Centro for the office setting.
Rest Of New York
New York · 42100
Office
$143.21
Facility
$97.20
$14.31 lower than El Centro for the office setting.
Ohio
Ohio · 42100
Office
$141.36
Facility
$97.14
$16.16 lower than El Centro for the office setting.
Oklahoma
Oklahoma · 42100
Office
$137.98
Facility
$94.73
$19.54 lower than El Centro for the office setting.
Portland
Oregon · 42100
Office
$160.19
Facility
$106.38
$2.67 higher than El Centro for the office setting.
Rest Of Oregon
Oregon · 42100
Office
$147.79
Facility
$99.55
$9.73 lower than El Centro for the office setting.
Metropolitan Philadelphia
Pennsylvania · 42100
Office
$156.01
Facility
$105.59
$1.51 lower than El Centro for the office setting.
Rest Of Pennsylvania
Pennsylvania · 42100
Office
$141.48
Facility
$97.02
$16.04 lower than El Centro for the office setting.
Puerto Rico
Puerto Rico · 42100
Office
$150.97
Facility
$102.01
$6.55 lower than El Centro for the office setting.
Rhode Island
Rhode Island · 42100
Office
$153.45
Facility
$103.42
$4.07 lower than El Centro for the office setting.
South Carolina
South Carolina · 42100
Office
$141.50
Facility
$96.75
$16.02 lower than El Centro for the office setting.
South Dakota**
South Dakota · 42100
Office
$145.98
Facility
$97.55
$11.54 lower than El Centro for the office setting.
Tennessee
Tennessee · 42100
Office
$138.13
Facility
$94.10
$19.39 lower than El Centro for the office setting.
Austin
Texas · 42100
Office
$155.15
Facility
$103.91
$2.37 lower than El Centro for the office setting.
Beaumont
Texas · 42100
Office
$140.59
Facility
$96.51
$16.93 lower than El Centro for the office setting.
Brazoria
Texas · 42100
Office
$148.11
Facility
$100.11
$9.41 lower than El Centro for the office setting.
Dallas
Texas · 42100
Office
$149.12
Facility
$100.88
$8.40 lower than El Centro for the office setting.
Fort Worth
Texas · 42100
Office
$148.20
Facility
$100.45
$9.32 lower than El Centro for the office setting.
Galveston
Texas · 42100
Office
$148.59
Facility
$100.50
$8.93 lower than El Centro for the office setting.
Houston
Texas · 42100
Office
$151.89
Facility
$103.80
$5.63 lower than El Centro for the office setting.
Rest Of Texas
Texas · 42100
Office
$144.31
Facility
$98.35
$13.21 lower than El Centro for the office setting.
Utah
Utah · 42100
Office
$143.38
Facility
$97.86
$14.14 lower than El Centro for the office setting.
Virginia
Virginia · 42100
Office
$146.51
Facility
$98.90
$11.01 lower than El Centro for the office setting.
Virgin Islands
United States Virgin Islands · 42100
Office
$150.97
Facility
$102.01
$6.55 lower than El Centro for the office setting.
Vermont
Vermont · 42100
Office
$146.00
Facility
$98.06
$11.52 lower than El Centro for the office setting.
Rest Of Washington
Washington · 42100
Office
$154.39
Facility
$103.39
$3.13 lower than El Centro for the office setting.
Seattle (King Cnty)
Washington · 42100
Office
$173.69
Facility
$114.26
$16.17 higher than El Centro for the office setting.
Wisconsin
Wisconsin · 42100
Office
$141.63
Facility
$95.23
$15.89 lower than El Centro for the office setting.
West Virginia
West Virginia · 42100
Office
$139.52
Facility
$97.44
$18.00 lower than El Centro for the office setting.
Wyoming**
Wyoming · 42100
Office
$148.41
Facility
$99.98
$9.11 lower than El Centro for the office setting.
See how rates vary across the country
42100 · Office / nonfacility · Non-QP. Choose a state to explore its payment localities. A range means the amount varies within that state.
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.
$133.02
$176.78
Color shows the midpoint of each state’s locality range.
View all state and territory rates as a table
| State / territory | Rate range | Localities |
|---|---|---|
| AK | $175.95 | 1 |
| AL | $134.92 | 1 |
| AR | $133.02 | 1 |
| AZ | $146.02 | 1 |
| CA | $157.49–$196.06 | 29 |
| CO | $155.56 | 1 |
| CT | $159.79 | 1 |
| DC | $170.77 | 1 |
| DE | $148.39 | 1 |
| FL | $148.61–$163.24 | 3 |
| GA | $140.37–$152.90 | 2 |
| GU | $161.08 | 1 |
| HI | $161.08 | 1 |
| IA | $137.88 | 1 |
| ID | $138.84 | 1 |
| IL | $144.70–$158.56 | 4 |
| IN | $139.61 | 1 |
| KS | $137.43 | 1 |
| KY | $138.41 | 1 |
| LA | $138.27–$144.92 | 2 |
| MA | $154.74–$170.44 | 2 |
| MD | $151.12–$170.77 | 3 |
| ME | $139.73–$146.86 | 2 |
| MI | $142.09–$150.61 | 2 |
| MN | $148.62 | 1 |
| MO | $136.08–$145.20 | 3 |
| MS | $134.57 | 1 |
| MT | $149.96 | 1 |
| NC | $141.13 | 1 |
| ND | $146.40 | 1 |
| NE | $138.57 | 1 |
| NH | $153.30 | 1 |
| NJ | $161.49–$169.10 | 2 |
| NM | $142.92 | 1 |
| NV | $149.07 | 1 |
| NY | $143.21–$176.78 | 5 |
| OH | $141.36 | 1 |
| OK | $137.98 | 1 |
| OR | $147.79–$160.19 | 2 |
| PA | $141.48–$156.01 | 2 |
| PR | $150.97 | 1 |
| RI | $153.45 | 1 |
| SC | $141.50 | 1 |
| SD | $145.98 | 1 |
| TN | $138.13 | 1 |
| TX | $140.59–$155.15 | 8 |
| UT | $143.38 | 1 |
| VA | $146.51–$170.77 | 2 |
| VI | $150.97 | 1 |
| VT | $146.00 | 1 |
| WA | $154.39–$173.69 | 2 |
| WI | $141.63 | 1 |
| WV | $139.52 | 1 |
| WY | $148.41 | 1 |
Where does this rate apply?
El Centro is a Medicare payment area. Our Census mapping connects it to 18 cities and communities in California, 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.
Why are the office and facility amounts different?
For 42100 in El Centro, the physician’s office rate is $157.52 and the facility-setting rate is $104.44: a difference of $53.08.
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.
Use this rate
What is a percentage of Medicare worth?
Turn a percentage into dollars for 42100 in El Centro. This uses the base rate on this page, so the locality and release stay consistent.
Reference amount per service
$173.27
$157.52 × 110% = $173.27
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.
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 42100 in El Centro.
PPRRVU2026_Oct_nonQPP.csv
4,993
- Code
- 42100
- Physician work
- 1.33
- Practice expense
- 2.98
- Malpractice
- 0.18
GPCI2026.csv
10
- Locality
- El Centro
- Physician work
- 1.017
- Practice expense
- 1.096
- Malpractice
- 0.541
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 1.33 | × 1.017 | 1.3526 |
| Practice expense | 2.98 | × 1.096 | 3.2661 |
| Malpractice | 0.18 | × 0.541 | 0.0974 |
| Total RVUs | 4.7161 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, El Centro$157.52
Open 42100 in the RVU calculator →
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 1.33 | 1.017 |
| Practice expense | 2.98 | 1.096 |
| Malpractice | 0.18 | 0.541 |
(1.33 × 1.017 + 2.98 × 1.096 + 0.18 × 0.541) × $33.4009 = $157.52
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 1.33 | 1.017 |
| Practice expense | 1.53 | 1.096 |
| Malpractice | 0.18 | 0.541 |
(1.33 × 1.017 + 1.53 × 1.096 + 0.18 × 0.541) × $33.4009 = $104.44
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
42100 · Office / nonfacility
$157.52
Effective 2026-10-01
The base rate is $9.20 higher than on 2025-10-01, moving from $148.32 to $157.52 (6.2%).
It is unchanged from the immediately preceding available release, effective 2026-07-01.
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
January 1, 2026
RVU26A
$148.32changed to$157.52
- Conversion factor 32.3465 changed to 33.4009
- Work RVU 1.36 changed to 1.33
- Practice expense RVU 2.85 changed to 2.98
- Malpractice RVU 0.16 changed to 0.18
- Work GPCI 1.014 changed to 1.017
- Practice expense GPCI 1.093 changed to 1.096
- Malpractice GPCI 0.570 changed to 0.541
Held through RVU26B, RVU26C, RVU26D.
January 1, 2025
RVU25A
Earliest loaded release: $148.32
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
42100 billing questions
When should this code be chosen instead of a palate excision code?
Use this code when the service is tissue sampling for diagnosis. When the procedure removes a palate lesion, consider the applicable excision code instead.
Can modifier 50 be reported for biopsies on both sides of the palate?
No. CMS identifies bilateral adjustment as inappropriate for this code because of the descriptor or anatomy.
Are related postoperative visits separately reported during the global period?
Related postoperative visits during the 10-day global period are included in the procedure.
What documentation supports reporting a palatal biopsy?
Document the palate site sampled, the clinical finding or concern that prompted sampling, and that tissue was obtained for diagnostic evaluation.
Can an assistant surgeon or co-surgeon be billed?
Medicare does not pay an assistant at surgery for this service, and co-surgeon and team-surgery billing 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.
