$230.94
42104 is for a more limited lesion excision without closure. Use 42120 when the documented work involves extensive lesion removal or substantial palate resection.
On this page
CMS RVU26D · Effective 2026-10-01
42120 in Redding
Office / nonfacility
Not available in this setting
Base rate per service
Facility setting
$937.63
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.
Otolaryngology surgery
About 42120: Extensive palate lesion resection
Reports substantial surgical removal of palatal tissue or an extensive palate lesion, rather than a limited lesion excision or diagnostic biopsy.
An otolaryngologist or oral and maxillofacial surgeon reports this service when surgery removes a substantial portion of the palate or requires extensive excision of a palatal lesion. It is typically performed in an operating room, often for a sizable tumor or other lesion whose extent calls for more than a localized excision. The resected tissue may be submitted for pathologic examination.
Choose this code based on the operative extent and tissue removed, not the lesion diagnosis alone. The operative report should describe the palatal site, lesion extent, amount of tissue resected, and surgical work performed; limited lesion excision belongs to the more specific excision codes when their criteria are met. Medicare assigns a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. For multiple procedures in one session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% reduction. Bilateral adjustment is inappropriate. Assistant-at-surgery payment may be available; co-surgeon payment requires supporting documentation, and team surgery is not permitted.
CMS billing rules for 42120
- Global period
- Major surgery with a 90-day global period: the day-before preoperative visit and 90 days of related postoperative care 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 may be paid.
- Co-surgeons
- Co-surgeons paid only with supporting documentation.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU11.56 · 42%
- Practice expense (office) RVU14.06 · 51%
- Malpractice RVU1.69 · 6%
327
Medicare services in 2024 · #3930 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.
42120 compared with similar codes
Office rates for Redding, from the same CMS release.
$276.04
42106 describes limited lesion excision with simple repair. It does not represent extensive palate resection.
$493.02
42107 describes limited lesion excision with complex repair. Distinguish it from 42120 by the extent of tissue resected, not simply by the complexity of closure.
$157.49
42100 is for obtaining a palatal biopsy specimen. It is not the code for definitive extensive removal of the palate or a lesion.
The same code, a different location
How does Redding compare?
42120 across payment areas
Same release and payment basis · bars start at $0
Redding · This locality
Unavailable
Unavailable
No comparable rate is available in this setting.
Unavailable
No comparable rate is available in this setting.
Unavailable
No comparable rate is available in this setting.
Unavailable
No comparable rate is available in this setting.
Unavailable
No comparable rate is available in this setting.
No comparable rate is available in this setting.
Other payment areas listed in California appear first, followed by selected cross-country examples. The chart compares amounts, not distance.
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
Madera
California · 42120
Office
Unavailable
Facility
$937.63
No comparable office rate is available.
Merced
California · 42120
Office
Unavailable
Facility
$937.63
No comparable office rate is available.
Modesto
California · 42120
Office
Unavailable
Facility
$937.63
No comparable office rate is available.
Napa
California · 42120
Office
Unavailable
Facility
$1058.07
No comparable office rate is available.
Oxnard-Thousand Oaks-Ventura
California · 42120
Office
Unavailable
Facility
$987.18
No comparable office rate is available.
Rest Of California
California · 42120
Office
Unavailable
Facility
$937.63
No comparable office rate is available.
Riverside-San Bernardino-Ontario
California · 42120
Office
Unavailable
Facility
$955.91
No comparable office rate is available.
Sacramento-Roseville-Folsom
California · 42120
Office
Unavailable
Facility
$976.43
No comparable office rate is available.
Salinas
California · 42120
Office
Unavailable
Facility
$972.63
No comparable office rate is available.
San Diego-Chula Vista-Carlsbad
California · 42120
Office
Unavailable
Facility
$989.95
No comparable office rate is available.
San Francisco-Oakland-Berkeley (Marin Cnty)
California · 42120
Office
Unavailable
Facility
$1110.86
No comparable office rate is available.
San Francisco-Oakland-Berkeley (San Francisco/San Mateo/Alameda/Contra Costa Cnty)
California · 42120
Office
Unavailable
Facility
$1108.94
No comparable office rate is available.
San Jose-Sunnyvale-Santa Clara (San Benito Cnty)
California · 42120
Office
Unavailable
Facility
$1136.03
No comparable office rate is available.
San Jose-Sunnyvale-Santa Clara (Santa Clara Cnty)
California · 42120
Office
Unavailable
Facility
$1128.18
No comparable office rate is available.
San Luis Obispo-Paso Robles
California · 42120
Office
Unavailable
Facility
$957.83
No comparable office rate is available.
Santa Cruz-Watsonville
California · 42120
Office
Unavailable
Facility
$995.06
No comparable office rate is available.
Santa Maria-Santa Barbara
California · 42120
Office
Unavailable
Facility
$974.75
No comparable office rate is available.
Santa Rosa-Petaluma
California · 42120
Office
Unavailable
Facility
$1004.64
No comparable office rate is available.
Stockton
California · 42120
Office
Unavailable
Facility
$937.63
No comparable office rate is available.
Vallejo
California · 42120
Office
Unavailable
Facility
$1055.30
No comparable office rate is available.
Visalia
California · 42120
Office
Unavailable
Facility
$937.63
No comparable office rate is available.
Yuba City
California · 42120
Office
Unavailable
Facility
$937.63
No comparable office rate is available.
Dc + Md/Va Suburbs
District of Columbia · 42120
Office
Unavailable
Facility
$1023.00
No comparable office rate is available.
Miami
Florida · 42120
Office
Unavailable
Facility
$1017.74
No comparable office rate is available.
Chicago
Illinois · 42120
Office
Unavailable
Facility
$990.33
No comparable office rate is available.
Manhattan
New York · 42120
Office
Unavailable
Facility
$1046.05
No comparable office rate is available.
Alaska*
Alaska · 42120
Office
Unavailable
Facility
$1110.42
No comparable office rate is available.
Alabama
Alabama · 42120
Office
Unavailable
Facility
$828.98
No comparable office rate is available.
Arkansas
Arkansas · 42120
Office
Unavailable
Facility
$818.59
No comparable office rate is available.
Arizona
Arizona · 42120
Office
Unavailable
Facility
$889.49
No comparable office rate is available.
Colorado
Colorado · 42120
Office
Unavailable
Facility
$934.51
No comparable office rate is available.
Connecticut
Connecticut · 42120
Office
Unavailable
Facility
$967.92
No comparable office rate is available.
Delaware
Delaware · 42120
Office
Unavailable
Facility
$902.77
No comparable office rate is available.
Fort Lauderdale
Florida · 42120
Office
Unavailable
Facility
$963.89
No comparable office rate is available.
Rest Of Florida
Florida · 42120
Office
Unavailable
Facility
$919.91
No comparable office rate is available.
Atlanta
Georgia · 42120
Office
Unavailable
Facility
$932.20
No comparable office rate is available.
Rest Of Georgia
Georgia · 42120
Office
Unavailable
Facility
$872.30
No comparable office rate is available.
Hawaii, Guam
Hawaii · 42120
Office
Unavailable
Facility
$952.75
No comparable office rate is available.
Iowa
Iowa · 42120
Office
Unavailable
Facility
$838.22
No comparable office rate is available.
Idaho
Idaho · 42120
Office
Unavailable
Facility
$844.86
No comparable office rate is available.
East St. Louis
Illinois · 42120
Office
Unavailable
Facility
$931.85
No comparable office rate is available.
Rest Of Illinois
Illinois · 42120
Office
Unavailable
Facility
$903.10
No comparable office rate is available.
Suburban Chicago
Illinois · 42120
Office
Unavailable
Facility
$971.14
No comparable office rate is available.
Indiana
Indiana · 42120
Office
Unavailable
Facility
$848.88
No comparable office rate is available.
Kansas
Kansas · 42120
Office
Unavailable
Facility
$839.10
No comparable office rate is available.
Kentucky
Kentucky · 42120
Office
Unavailable
Facility
$855.25
No comparable office rate is available.
New Orleans
Louisiana · 42120
Office
Unavailable
Facility
$892.15
No comparable office rate is available.
Rest Of Louisiana
Louisiana · 42120
Office
Unavailable
Facility
$855.80
No comparable office rate is available.
Metropolitan Boston
Massachusetts · 42120
Office
Unavailable
Facility
$1012.91
No comparable office rate is available.
Rest Of Massachusetts
Massachusetts · 42120
Office
Unavailable
Facility
$931.79
No comparable office rate is available.
Baltimore/Surr. Cntys
Maryland · 42120
Office
Unavailable
Facility
$966.02
No comparable office rate is available.
Rest Of Maryland
Maryland · 42120
Office
Unavailable
Facility
$917.05
No comparable office rate is available.
Rest Of Maine
Maine · 42120
Office
Unavailable
Facility
$853.27
No comparable office rate is available.
Southern Maine
Maine · 42120
Office
Unavailable
Facility
$887.12
No comparable office rate is available.
Detroit
Michigan · 42120
Office
Unavailable
Facility
$934.46
No comparable office rate is available.
Rest Of Michigan
Michigan · 42120
Office
Unavailable
Facility
$878.60
No comparable office rate is available.
Minnesota
Minnesota · 42120
Office
Unavailable
Facility
$886.06
No comparable office rate is available.
Metropolitan Kansas City
Missouri · 42120
Office
Unavailable
Facility
$882.23
No comparable office rate is available.
Metropolitan St. Louis
Missouri · 42120
Office
Unavailable
Facility
$889.75
No comparable office rate is available.
Rest Of Missouri
Missouri · 42120
Office
Unavailable
Facility
$845.90
No comparable office rate is available.
Mississippi
Mississippi · 42120
Office
Unavailable
Facility
$832.17
No comparable office rate is available.
Montana**
Montana · 42120
Office
Unavailable
Facility
$912.07
No comparable office rate is available.
North Carolina
North Carolina · 42120
Office
Unavailable
Facility
$860.34
No comparable office rate is available.
North Dakota**
North Dakota · 42120
Office
Unavailable
Facility
$878.65
No comparable office rate is available.
Nebraska
Nebraska · 42120
Office
Unavailable
Facility
$840.91
No comparable office rate is available.
New Hampshire
New Hampshire · 42120
Office
Unavailable
Facility
$924.38
No comparable office rate is available.
Northern Nj
New Jersey · 42120
Office
Unavailable
Facility
$1015.48
No comparable office rate is available.
Rest Of New Jersey
New Jersey · 42120
Office
Unavailable
Facility
$976.30
No comparable office rate is available.
New Mexico
New Mexico · 42120
Office
Unavailable
Facility
$884.55
No comparable office rate is available.
Nevada**
Nevada · 42120
Office
Unavailable
Facility
$903.22
No comparable office rate is available.
Nyc Suburbs/Long Island
New York · 42120
Office
Unavailable
Facility
$1074.02
No comparable office rate is available.
Poughkpsie/N Nyc Suburbs
New York · 42120
Office
Unavailable
Facility
$986.02
No comparable office rate is available.
Queens
New York · 42120
Office
Unavailable
Facility
$1047.31
No comparable office rate is available.
Rest Of New York
New York · 42120
Office
Unavailable
Facility
$871.93
No comparable office rate is available.
Ohio
Ohio · 42120
Office
Unavailable
Facility
$871.77
No comparable office rate is available.
Oklahoma
Oklahoma · 42120
Office
Unavailable
Facility
$849.34
No comparable office rate is available.
Portland
Oregon · 42120
Office
Unavailable
Facility
$956.03
No comparable office rate is available.
Rest Of Oregon
Oregon · 42120
Office
Unavailable
Facility
$893.54
No comparable office rate is available.
Metropolitan Philadelphia
Pennsylvania · 42120
Office
Unavailable
Facility
$949.28
No comparable office rate is available.
Rest Of Pennsylvania
Pennsylvania · 42120
Office
Unavailable
Facility
$870.57
No comparable office rate is available.
Puerto Rico
Puerto Rico · 42120
Office
Unavailable
Facility
$916.50
No comparable office rate is available.
Rhode Island
Rhode Island · 42120
Office
Unavailable
Facility
$928.92
No comparable office rate is available.
South Carolina
South Carolina · 42120
Office
Unavailable
Facility
$868.02
No comparable office rate is available.
South Dakota**
South Dakota · 42120
Office
Unavailable
Facility
$874.70
No comparable office rate is available.
Tennessee
Tennessee · 42120
Office
Unavailable
Facility
$843.31
No comparable office rate is available.
Austin
Texas · 42120
Office
Unavailable
Facility
$933.75
No comparable office rate is available.
Beaumont
Texas · 42120
Office
Unavailable
Facility
$865.91
No comparable office rate is available.
Brazoria
Texas · 42120
Office
Unavailable
Facility
$898.62
No comparable office rate is available.
Dallas
Texas · 42120
Office
Unavailable
Facility
$905.76
No comparable office rate is available.
Fort Worth
Texas · 42120
Office
Unavailable
Facility
$901.80
No comparable office rate is available.
Galveston
Texas · 42120
Office
Unavailable
Facility
$902.27
No comparable office rate is available.
Houston
Texas · 42120
Office
Unavailable
Facility
$933.20
No comparable office rate is available.
Rest Of Texas
Texas · 42120
Office
Unavailable
Facility
$882.75
No comparable office rate is available.
Utah
Utah · 42120
Office
Unavailable
Facility
$878.24
No comparable office rate is available.
Virginia
Virginia · 42120
Office
Unavailable
Facility
$887.60
No comparable office rate is available.
Virgin Islands
United States Virgin Islands · 42120
Office
Unavailable
Facility
$916.50
No comparable office rate is available.
Vermont
Vermont · 42120
Office
Unavailable
Facility
$879.60
No comparable office rate is available.
Rest Of Washington
Washington · 42120
Office
Unavailable
Facility
$928.60
No comparable office rate is available.
Seattle (King Cnty)
Washington · 42120
Office
Unavailable
Facility
$1027.76
No comparable office rate is available.
Wisconsin
Wisconsin · 42120
Office
Unavailable
Facility
$853.39
No comparable office rate is available.
West Virginia
West Virginia · 42120
Office
Unavailable
Facility
$874.99
No comparable office rate is available.
Wyoming**
Wyoming · 42120
Office
Unavailable
Facility
$897.50
No comparable office rate is available.
See how rates vary across the country
42120 · 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.
View all state and territory rates as a table
| State / territory | Rate range | Localities |
|---|---|---|
| AK | No published base rate | 1 |
| AL | No published base rate | 1 |
| AR | No published base rate | 1 |
| AZ | No published base rate | 1 |
| CA | No published base rate | 29 |
| CO | No published base rate | 1 |
| CT | No published base rate | 1 |
| DC | No published base rate | 1 |
| DE | No published base rate | 1 |
| FL | No published base rate | 3 |
| GA | No published base rate | 2 |
| GU | No published base rate | 1 |
| HI | No published base rate | 1 |
| IA | No published base rate | 1 |
| ID | No published base rate | 1 |
| IL | No published base rate | 4 |
| IN | No published base rate | 1 |
| KS | No published base rate | 1 |
| KY | No published base rate | 1 |
| LA | No published base rate | 2 |
| MA | No published base rate | 2 |
| MD | No published base rate | 3 |
| ME | No published base rate | 2 |
| MI | No published base rate | 2 |
| MN | No published base rate | 1 |
| MO | No published base rate | 3 |
| MS | No published base rate | 1 |
| MT | No published base rate | 1 |
| NC | No published base rate | 1 |
| ND | No published base rate | 1 |
| NE | No published base rate | 1 |
| NH | No published base rate | 1 |
| NJ | No published base rate | 2 |
| NM | No published base rate | 1 |
| NV | No published base rate | 1 |
| NY | No published base rate | 5 |
| OH | No published base rate | 1 |
| OK | No published base rate | 1 |
| OR | No published base rate | 2 |
| PA | No published base rate | 2 |
| PR | No published base rate | 1 |
| RI | No published base rate | 1 |
| SC | No published base rate | 1 |
| SD | No published base rate | 1 |
| TN | No published base rate | 1 |
| TX | No published base rate | 8 |
| UT | No published base rate | 1 |
| VA | No published base rate | 2 |
| VI | No published base rate | 1 |
| VT | No published base rate | 1 |
| WA | No published base rate | 2 |
| WI | No published base rate | 1 |
| WV | No published base rate | 1 |
| WY | No published base rate | 1 |
Where does this rate apply?
Redding is a Medicare payment area. Our Census mapping connects it to 32 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.
Use this rate
What is a percentage of Medicare worth?
Turn a percentage into dollars for 42120 in Redding. This uses the base rate on this page, so the locality and release stay consistent.
Reference amount per service
$1031.39
$937.63 × 110% = $1031.39
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 42120 in Redding.
PPRRVU2026_Oct_nonQPP.csv
4,998
- Code
- 42120
- Physician work
- 11.56
- Practice expense
- 14.06
- Malpractice
- 1.69
GPCI2026.csv
19
- Locality
- Redding
- Physician work
- 1.017
- Practice expense
- 1.096
- Malpractice
- 0.536
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 11.56 | × 1.017 | 11.7565 |
| Practice expense | 14.06 | × 1.096 | 15.4098 |
| Malpractice | 1.69 | × 0.536 | 0.9058 |
| Total RVUs | 28.0721 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Redding$937.63
Open 42120 in the RVU calculator →
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 11.56 | 1.017 |
| Practice expense | 14.06 | 1.096 |
| Malpractice | 1.69 | 0.536 |
(11.56 × 1.017 + 14.06 × 1.096 + 1.69 × 0.536) × $33.4009 = $937.63
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
42120 · Office / nonfacility
Rate unavailable
Effective 2026-10-01
A rate is unavailable in one of these releases, so a change cannot be calculated.
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
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 from | Office / nonfacility | Facility | CMS release |
|---|---|---|---|
| 2026-10-01 | Not available in this setting | $937.63 | RVU26D |
| 2026-07-01 | Not available in this setting | $937.63 | RVU26C |
| 2026-04-01 | Not available in this setting | $937.63 | RVU26B |
| 2026-01-01 | Not available in this setting | $937.63 | RVU26A |
| 2025-10-01 | Not available in this setting | $1005.47 | RVU25D |
| 2025-07-01 | Not available in this setting | $1005.47 | RVU25C |
| 2025-04-01 | Not available in this setting | $1005.47 | RVU25B |
| 2025-01-01 | Not available in this setting | $1005.47 | RVU25A |
42120 billing questions
How does this differ from codes 42104, 42106, and 42107?
Those codes describe more limited palatal lesion excisions, distinguished by closure. Use 42120 when the operative work is an extensive lesion resection or substantial palate resection, rather than choosing it solely because a lesion is present.
Does the diagnosis alone support reporting 42120?
No. The operative report should establish the extent of the resection and the palate tissue removed; a tumor diagnosis by itself does not distinguish an extensive resection from a limited excision.
Should modifier 50 be used for bilateral work?
No. CMS identifies bilateral adjustment as inappropriate for this code.
What happens when another procedure is performed in the same session?
Under the standard multiple-procedure rule, the highest-valued procedure is paid in full and other procedures are paid at 50% when performed in the same session.
Can an assistant or co-surgeon be reported?
Assistant-at-surgery payment may be available. Co-surgeon payment requires supporting documentation; team surgery is 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.
4,99542106,,Excision lesion mouth roof,A,,2.10,5.46,,2.12,,0.27,7.83,4.49,0,010,0.10,0.80,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,99642107,,Excision lesion mouth roof,A,,4.45,9.05,,4.08,,0.59,14.09,9.12,0,090,0.09,0.81,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,9974210F,,Ace/arb thxpy for mos/>,I,,0.00,0.00,,0.00,,0.00,0.00,0.00,9,XXX,0.00,0.00,0.00,9,9,9,9,9,9,,33.4009,09,0,99,0.00,0.00,0.00
4,99842120,,Remove palate/lesion,A,,11.56,14.06,NA,14.06,,1.69,27.31,27.31,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,99942140,,Excision of uvula,A,,1.66,7.24,,2.66,,0.23,9.13,4.55,0,090,0.09,0.81,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,00042145,,Repair palate pharynx/uvula,A,,9.54,7.29,NA,7.29,,1.39,18.22,18.22,0,090,0.09,0.81,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,00142160,,Treatment mouth roof lesion,A,,1.80,4.94,,1.84,,0.22,6.96,3.86,0,010,0.10,0.80,0.10,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1601112,CA,60,MODESTO,1.017,1.096,0.536
1701112,CA,51,NAPA,1.063,1.318,0.508
1801182,CA,17,OXNARD-THOUSAND OAKS-VENTURA,1.028,1.182,0.623
1901112,CA,61,REDDING,1.017,1.096,0.536
2001112,CA,62,RIVERSIDE-SAN BERNARDINO-ONTARIO,1.018,1.096,0.853
2101112,CA,63,SACRAMENTO-ROSEVILLE-FOLSOM,1.036,1.163,0.536
2201112,CA,64,SALINAS,1.031,1.159,0.536