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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.

42104

Palatal excision

Without closure

$230.98

42100 describes diagnostic tissue sampling. 42104 is for excision of a palate lesion 1 cm or less.

42106

Palate excision

Simple primary closure

$276.09

42100 describes diagnostic tissue sampling. 42106 is for excision of a palate lesion over 1 cm.

42107

Palatal lesion excision

With complex repair

$493.12

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

  1. El Centro · This locality

    $157.52

  2. $0.50 higher than El Centro

  3. Chico

    $157.49

    $0.03 lower than El Centro

  4. Fresno

    $157.49

    $0.03 lower than El Centro

  5. $0.03 lower than El Centro

  6. $10.47 higher than El Centro

  7. Madera

    $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 / territoryRate rangeLocalities
AK$175.951
AL$134.921
AR$133.021
AZ$146.021
CA$157.49–$196.0629
CO$155.561
CT$159.791
DC$170.771
DE$148.391
FL$148.61–$163.243
GA$140.37–$152.902
GU$161.081
HI$161.081
IA$137.881
ID$138.841
IL$144.70–$158.564
IN$139.611
KS$137.431
KY$138.411
LA$138.27–$144.922
MA$154.74–$170.442
MD$151.12–$170.773
ME$139.73–$146.862
MI$142.09–$150.612
MN$148.621
MO$136.08–$145.203
MS$134.571
MT$149.961
NC$141.131
ND$146.401
NE$138.571
NH$153.301
NJ$161.49–$169.102
NM$142.921
NV$149.071
NY$143.21–$176.785
OH$141.361
OK$137.981
OR$147.79–$160.192
PA$141.48–$156.012
PR$150.971
RI$153.451
SC$141.501
SD$145.981
TN$138.131
TX$140.59–$155.158
UT$143.381
VA$146.51–$170.772
VI$150.971
VT$146.001
WA$154.39–$173.692
WI$141.631
WV$139.521
WY$148.411

Explore 42100 on the national rate map →

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.

See the inputs behind this difference →

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.

Compare your contract offer →

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
Office / nonfacility calculation for 42100 in El Centro
ComponentRVULocality factorAdjusted
Physician work1.33× 1.0171.3526
Practice expense2.98× 1.0963.2661
Malpractice0.18× 0.5410.0974
Total RVUs4.7161
Conversion factor× 33.4009

Office / nonfacility rate, El Centro$157.52

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

Open 42100 in the RVU calculator →

Explore RVUs, geographic factors and the full formula

Office / nonfacility

Office / nonfacility calculation inputs
ComponentRVULocal GPCI
Work1.331.017
Practice expense2.981.096
Malpractice0.180.541

(1.33 × 1.017 + 2.98 × 1.096 + 0.18 × 0.541) × $33.4009 = $157.52

Facility

Facility calculation inputs
ComponentRVULocal GPCI
Work1.331.017
Practice expense1.531.096
Malpractice0.180.541

(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.

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

    $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.

  2. 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
Effective fromOffice / nonfacilityFacilityCMS release
2026-10-01$157.52$104.44RVU26D
2026-07-01$157.52$104.44RVU26C
2026-04-01$157.52$104.44RVU26B
2026-01-01$157.52$104.44RVU26A
2025-10-01$148.32$112.26RVU25D
2025-07-01$148.32$112.26RVU25C
2025-04-01$148.32$112.26RVU25B
2025-01-01$148.32$112.26RVU25A

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.

RVUs for 42100PPRRVU2026_Oct_nonQPP.csv, line 4,993 (RVU26D)
Geographic factors for El CentroGPCI2026.csv, line 10 (RVU26D)