No office rate
42200 is for a limited primary or secondary cleft palate repair. Use 42215 when the secondary repair includes the muscle repositioning specified for that code.
On this page
CMS RVU26D · Effective 2026-10-01
42215 in Redding
Office / nonfacility
Not available in this setting
Base rate per service
Facility setting
$657.65
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 surgery
About 42215: Secondary cleft palate repair with muscle repositioning
Reports secondary cleft palate reconstruction with repositioning of palatal muscles, commonly performed to improve palatal function after an earlier repair.
This operation repairs a previously treated cleft palate and repositions the palatal muscles as part of the reconstruction. It may be performed for a patient with persistent palatal dysfunction after an earlier cleft repair. Plastic surgeons, otolaryngologists, and oral and maxillofacial surgeons may perform the procedure, typically in an operating room. The operative report should identify the prior repair and document the muscle repositioning and reconstructive work performed.
Report 42215 when the documented procedure matches this secondary repair with muscle repositioning, rather than selecting a code based only on the diagnosis of cleft palate. The 90-day global period includes 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 the others are subject to the standard multiple-procedure reduction. Modifier 50 is inappropriate for this code. An assistant at surgery may be paid; co-surgeons and team surgery are not permitted.
CMS billing rules for 42215
- 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 not permitted.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU8.77 · 45%
- Practice expense (office) RVU9.03 · 46%
- Malpractice RVU1.63 · 8%
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.
42215 compared with similar codes
Office rates for Redding, from the same CMS release.
No office rate
42205 describes an extensive primary or secondary repair. 42215 identifies secondary reconstruction with muscle repositioning rather than extent alone.
No office rate
42210 includes bone grafting to the alveolus. 42215 is the secondary repair with muscle repositioning; select based on the procedure actually documented.
No office rate
42220 involves a pharyngeal flap in secondary cleft palate repair. 42215 describes secondary repair with muscle repositioning.
The same code, a different location
How does Redding compare?
42215 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 · 42215
Office
Unavailable
Facility
$657.65
No comparable office rate is available.
Merced
California · 42215
Office
Unavailable
Facility
$657.65
No comparable office rate is available.
Modesto
California · 42215
Office
Unavailable
Facility
$657.65
No comparable office rate is available.
Napa
California · 42215
Office
Unavailable
Facility
$736.56
No comparable office rate is available.
Oxnard-Thousand Oaks-Ventura
California · 42215
Office
Unavailable
Facility
$691.55
No comparable office rate is available.
Rest Of California
California · 42215
Office
Unavailable
Facility
$657.65
No comparable office rate is available.
Riverside-San Bernardino-Ontario
California · 42215
Office
Unavailable
Facility
$675.20
No comparable office rate is available.
Sacramento-Roseville-Folsom
California · 42215
Office
Unavailable
Facility
$683.43
No comparable office rate is available.
Salinas
California · 42215
Office
Unavailable
Facility
$680.75
No comparable office rate is available.
San Diego-Chula Vista-Carlsbad
California · 42215
Office
Unavailable
Facility
$691.95
No comparable office rate is available.
San Francisco-Oakland-Berkeley (Marin Cnty)
California · 42215
Office
Unavailable
Facility
$771.01
No comparable office rate is available.
San Francisco-Oakland-Berkeley (San Francisco/San Mateo/Alameda/Contra Costa Cnty)
California · 42215
Office
Unavailable
Facility
$769.16
No comparable office rate is available.
San Jose-Sunnyvale-Santa Clara (San Benito Cnty)
California · 42215
Office
Unavailable
Facility
$789.25
No comparable office rate is available.
San Jose-Sunnyvale-Santa Clara (Santa Clara Cnty)
California · 42215
Office
Unavailable
Facility
$781.68
No comparable office rate is available.
San Luis Obispo-Paso Robles
California · 42215
Office
Unavailable
Facility
$670.62
No comparable office rate is available.
Santa Cruz-Watsonville
California · 42215
Office
Unavailable
Facility
$694.72
No comparable office rate is available.
Santa Maria-Santa Barbara
California · 42215
Office
Unavailable
Facility
$681.99
No comparable office rate is available.
Santa Rosa-Petaluma
California · 42215
Office
Unavailable
Facility
$701.27
No comparable office rate is available.
Stockton
California · 42215
Office
Unavailable
Facility
$657.65
No comparable office rate is available.
Vallejo
California · 42215
Office
Unavailable
Facility
$733.89
No comparable office rate is available.
Visalia
California · 42215
Office
Unavailable
Facility
$657.65
No comparable office rate is available.
Yuba City
California · 42215
Office
Unavailable
Facility
$657.65
No comparable office rate is available.
Dc + Md/Va Suburbs
District of Columbia · 42215
Office
Unavailable
Facility
$724.64
No comparable office rate is available.
Miami
Florida · 42215
Office
Unavailable
Facility
$744.59
No comparable office rate is available.
Chicago
Illinois · 42215
Office
Unavailable
Facility
$723.04
No comparable office rate is available.
Manhattan
New York · 42215
Office
Unavailable
Facility
$748.49
No comparable office rate is available.
Alaska*
Alaska · 42215
Office
Unavailable
Facility
$790.60
No comparable office rate is available.
Alabama
Alabama · 42215
Office
Unavailable
Facility
$587.65
No comparable office rate is available.
Arkansas
Arkansas · 42215
Office
Unavailable
Facility
$580.05
No comparable office rate is available.
Arizona
Arizona · 42215
Office
Unavailable
Facility
$631.79
No comparable office rate is available.
Colorado
Colorado · 42215
Office
Unavailable
Facility
$659.87
No comparable office rate is available.
Connecticut
Connecticut · 42215
Office
Unavailable
Facility
$689.50
No comparable office rate is available.
Delaware
Delaware · 42215
Office
Unavailable
Facility
$641.33
No comparable office rate is available.
Fort Lauderdale
Florida · 42215
Office
Unavailable
Facility
$696.89
No comparable office rate is available.
Rest Of Florida
Florida · 42215
Office
Unavailable
Facility
$663.09
No comparable office rate is available.
Atlanta
Georgia · 42215
Office
Unavailable
Facility
$665.63
No comparable office rate is available.
Rest Of Georgia
Georgia · 42215
Office
Unavailable
Facility
$626.86
No comparable office rate is available.
Hawaii, Guam
Hawaii · 42215
Office
Unavailable
Facility
$667.38
No comparable office rate is available.
Iowa
Iowa · 42215
Office
Unavailable
Facility
$590.51
No comparable office rate is available.
Idaho
Idaho · 42215
Office
Unavailable
Facility
$596.16
No comparable office rate is available.
East St. Louis
Illinois · 42215
Office
Unavailable
Facility
$680.06
No comparable office rate is available.
Rest Of Illinois
Illinois · 42215
Office
Unavailable
Facility
$653.39
No comparable office rate is available.
Suburban Chicago
Illinois · 42215
Office
Unavailable
Facility
$701.20
No comparable office rate is available.
Indiana
Indiana · 42215
Office
Unavailable
Facility
$598.98
No comparable office rate is available.
Kansas
Kansas · 42215
Office
Unavailable
Facility
$593.02
No comparable office rate is available.
Kentucky
Kentucky · 42215
Office
Unavailable
Facility
$610.87
No comparable office rate is available.
New Orleans
Louisiana · 42215
Office
Unavailable
Facility
$638.59
No comparable office rate is available.
Rest Of Louisiana
Louisiana · 42215
Office
Unavailable
Facility
$612.01
No comparable office rate is available.
Metropolitan Boston
Massachusetts · 42215
Office
Unavailable
Facility
$713.51
No comparable office rate is available.
Rest Of Massachusetts
Massachusetts · 42215
Office
Unavailable
Facility
$658.60
No comparable office rate is available.
Baltimore/Surr. Cntys
Maryland · 42215
Office
Unavailable
Facility
$688.59
No comparable office rate is available.
Rest Of Maryland
Maryland · 42215
Office
Unavailable
Facility
$651.06
No comparable office rate is available.
Rest Of Maine
Maine · 42215
Office
Unavailable
Facility
$604.27
No comparable office rate is available.
Southern Maine
Maine · 42215
Office
Unavailable
Facility
$626.18
No comparable office rate is available.
Detroit
Michigan · 42215
Office
Unavailable
Facility
$675.77
No comparable office rate is available.
Rest Of Michigan
Michigan · 42215
Office
Unavailable
Facility
$629.76
No comparable office rate is available.
Minnesota
Minnesota · 42215
Office
Unavailable
Facility
$619.40
No comparable office rate is available.
Metropolitan Kansas City
Missouri · 42215
Office
Unavailable
Facility
$629.33
No comparable office rate is available.
Metropolitan St. Louis
Missouri · 42215
Office
Unavailable
Facility
$634.61
No comparable office rate is available.
Rest Of Missouri
Missouri · 42215
Office
Unavailable
Facility
$605.94
No comparable office rate is available.
Mississippi
Mississippi · 42215
Office
Unavailable
Facility
$592.85
No comparable office rate is available.
Montana**
Montana · 42215
Office
Unavailable
Facility
$648.87
No comparable office rate is available.
North Carolina
North Carolina · 42215
Office
Unavailable
Facility
$609.12
No comparable office rate is available.
North Dakota**
North Dakota · 42215
Office
Unavailable
Facility
$616.64
No comparable office rate is available.
Nebraska
Nebraska · 42215
Office
Unavailable
Facility
$591.89
No comparable office rate is available.
New Hampshire
New Hampshire · 42215
Office
Unavailable
Facility
$654.54
No comparable office rate is available.
Northern Nj
New Jersey · 42215
Office
Unavailable
Facility
$719.39
No comparable office rate is available.
Rest Of New Jersey
New Jersey · 42215
Office
Unavailable
Facility
$693.73
No comparable office rate is available.
New Mexico
New Mexico · 42215
Office
Unavailable
Facility
$634.89
No comparable office rate is available.
Nevada**
Nevada · 42215
Office
Unavailable
Facility
$640.19
No comparable office rate is available.
Nyc Suburbs/Long Island
New York · 42215
Office
Unavailable
Facility
$771.39
No comparable office rate is available.
Poughkpsie/N Nyc Suburbs
New York · 42215
Office
Unavailable
Facility
$702.25
No comparable office rate is available.
Queens
New York · 42215
Office
Unavailable
Facility
$746.68
No comparable office rate is available.
Rest Of New York
New York · 42215
Office
Unavailable
Facility
$617.73
No comparable office rate is available.
Ohio
Ohio · 42215
Office
Unavailable
Facility
$623.17
No comparable office rate is available.
Oklahoma
Oklahoma · 42215
Office
Unavailable
Facility
$604.57
No comparable office rate is available.
Portland
Oregon · 42215
Office
Unavailable
Facility
$673.21
No comparable office rate is available.
Rest Of Oregon
Oregon · 42215
Office
Unavailable
Facility
$631.60
No comparable office rate is available.
Metropolitan Philadelphia
Pennsylvania · 42215
Office
Unavailable
Facility
$677.13
No comparable office rate is available.
Rest Of Pennsylvania
Pennsylvania · 42215
Office
Unavailable
Facility
$621.25
No comparable office rate is available.
Puerto Rico
Puerto Rico · 42215
Office
Unavailable
Facility
$651.48
No comparable office rate is available.
Rhode Island
Rhode Island · 42215
Office
Unavailable
Facility
$658.62
No comparable office rate is available.
South Carolina
South Carolina · 42215
Office
Unavailable
Facility
$617.89
No comparable office rate is available.
South Dakota**
South Dakota · 42215
Office
Unavailable
Facility
$612.83
No comparable office rate is available.
Tennessee
Tennessee · 42215
Office
Unavailable
Facility
$596.33
No comparable office rate is available.
Austin
Texas · 42215
Office
Unavailable
Facility
$660.85
No comparable office rate is available.
Beaumont
Texas · 42215
Office
Unavailable
Facility
$617.97
No comparable office rate is available.
Brazoria
Texas · 42215
Office
Unavailable
Facility
$636.63
No comparable office rate is available.
Dallas
Texas · 42215
Office
Unavailable
Facility
$642.68
No comparable office rate is available.
Fort Worth
Texas · 42215
Office
Unavailable
Facility
$640.37
No comparable office rate is available.
Galveston
Texas · 42215
Office
Unavailable
Facility
$639.85
No comparable office rate is available.
Houston
Texas · 42215
Office
Unavailable
Facility
$669.68
No comparable office rate is available.
Rest Of Texas
Texas · 42215
Office
Unavailable
Facility
$628.32
No comparable office rate is available.
Utah
Utah · 42215
Office
Unavailable
Facility
$625.33
No comparable office rate is available.
Virginia
Virginia · 42215
Office
Unavailable
Facility
$627.85
No comparable office rate is available.
Virgin Islands
United States Virgin Islands · 42215
Office
Unavailable
Facility
$651.48
No comparable office rate is available.
Vermont
Vermont · 42215
Office
Unavailable
Facility
$619.07
No comparable office rate is available.
Rest Of Washington
Washington · 42215
Office
Unavailable
Facility
$655.76
No comparable office rate is available.
Seattle (King Cnty)
Washington · 42215
Office
Unavailable
Facility
$722.13
No comparable office rate is available.
Wisconsin
Wisconsin · 42215
Office
Unavailable
Facility
$598.64
No comparable office rate is available.
West Virginia
West Virginia · 42215
Office
Unavailable
Facility
$632.93
No comparable office rate is available.
Wyoming**
Wyoming · 42215
Office
Unavailable
Facility
$634.82
No comparable office rate is available.
See how rates vary across the country
42215 · 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 42215 in Redding. This uses the base rate on this page, so the locality and release stay consistent.
Reference amount per service
$723.42
$657.65 × 110% = $723.42
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 42215 in Redding.
PPRRVU2026_Oct_nonQPP.csv
5,008
- Code
- 42215
- Physician work
- 8.77
- Practice expense
- 9.03
- Malpractice
- 1.63
GPCI2026.csv
19
- Locality
- Redding
- Physician work
- 1.017
- Practice expense
- 1.096
- Malpractice
- 0.536
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 8.77 | × 1.017 | 8.9191 |
| Practice expense | 9.03 | × 1.096 | 9.8969 |
| Malpractice | 1.63 | × 0.536 | 0.8737 |
| Total RVUs | 19.6897 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Redding$657.65
Open 42215 in the RVU calculator →
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 8.77 | 1.017 |
| Practice expense | 9.03 | 1.096 |
| Malpractice | 1.63 | 0.536 |
(8.77 × 1.017 + 9.03 × 1.096 + 1.63 × 0.536) × $33.4009 = $657.65
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
42215 · 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 | $657.65 | RVU26D |
| 2026-07-01 | Not available in this setting | $657.65 | RVU26C |
| 2026-04-01 | Not available in this setting | $657.65 | RVU26B |
| 2026-01-01 | Not available in this setting | $657.65 | RVU26A |
| 2025-10-01 | Not available in this setting | $701.81 | RVU25D |
| 2025-07-01 | Not available in this setting | $701.81 | RVU25C |
| 2025-04-01 | Not available in this setting | $701.81 | RVU25B |
| 2025-01-01 | Not available in this setting | $701.81 | RVU25A |
42215 billing questions
How does 42215 differ from 42200 or 42205?
42215 identifies a secondary cleft palate repair with muscle repositioning. Choose between 42200 and 42205 based on the limited or extensive repair described by those codes, not simply because the patient has a cleft palate.
How does 42215 differ from 42220?
42215 describes secondary repair with muscle repositioning. 42220 describes a secondary repair involving a pharyngeal flap, so the documented operative technique determines the choice.
What documentation supports reporting 42215?
The operative report should establish that this is a secondary cleft palate reconstruction and describe repositioning of the palatal muscles. A diagnosis of cleft palate alone does not establish the specific procedure.
Does the 90-day global period include related postoperative care?
Yes. The global period includes the day-before preoperative visit and 90 days of related postoperative care.
Can 42215 be billed with modifier 50?
No. The CMS bilateral adjustment does not apply to this code, and modifier 50 is inappropriate.
Can an assistant or co-surgeon be reported?
An assistant at surgery may be paid. Co-surgeons and team surgery are not permitted under the CMS rules for this code.
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.
5,00542205,,Reconstruct cleft palate,A,,13.32,10.19,NA,10.19,,2.48,25.99,25.99,0,090,0.09,0.81,0.10,2,0,2,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,0064220F,,Digoxin thxpy for 6 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
5,00742210,,Reconstruct cleft palate,A,,14.65,11.68,NA,11.68,,2.72,29.05,29.05,0,090,0.09,0.81,0.10,2,0,2,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,00842215,,Reconstruct cleft palate,A,,8.77,9.03,NA,9.03,,1.63,19.43,19.43,0,090,0.09,0.81,0.10,2,0,2,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,0094221F,,Diuretic thxpy for 6 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
5,01042220,,Reconstruct cleft palate,A,,6.98,7.87,NA,7.87,,1.30,16.15,16.15,0,090,0.09,0.81,0.10,2,0,2,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,01142225,,Reconstruct cleft palate,A,,9.53,17.73,NA,17.73,,1.76,29.02,29.02,0,090,0.09,0.81,0.10,2,0,2,0,0,9,,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