No office rate
Both codes describe palatal lengthening, but 42226 uses an island flap and 42227 uses a local flap. Use the flap technique documented in the operative report.
On this page
CMS RVU26D · Effective 2026-10-01
42226 in Utah
Office / nonfacility
Not available in this setting
Base rate per service
Facility setting
$802.77
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.
Cleft palate surgery
About 42226: Island-flap palatal lengthening
Reports surgical palatal lengthening using an island flap, commonly to address a short palate and persistent velopharyngeal dysfunction after cleft-palate repair.
This operation lengthens the palate by mobilizing an island flap of tissue while preserving its blood supply, then positioning it to add palatal reach. It may be performed for a short or scarred palate associated with velopharyngeal dysfunction, including in a patient with a history of cleft-palate repair. Plastic surgeons, otolaryngologists, and oral and maxillofacial surgeons with cleft or craniofacial expertise typically perform the procedure in an operating room.
Report 42226 when the operative work uses the island-flap approach; distinguish it from lengthening with a local flap or another secondary palatoplasty technique. The operative report should identify the indication, flap technique, tissue mobilization, and reconstructive work performed. CMS assigns a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and others at 50%. Modifier 50 is inappropriate for this palatal procedure. An assistant at surgery may be paid; co-surgeons and team surgery are not permitted.
CMS billing rules for 42226
- 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 RVU10.09 · 40%
- Practice expense (office) RVU13.43 · 54%
- Malpractice RVU1.47 · 6%
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.
42226 compared with similar codes
Office rates for Utah, from the same CMS release.
No office rate
42220 describes secondary palatoplasty to lengthen the palate. Choose 42226 when the documented lengthening is performed with an island flap.
No office rate
42225 describes secondary palatoplasty lengthening with additional cleft-palate repair work. 42226 identifies lengthening performed with an island flap.
The same code, a different location
How does Utah compare?
42226 across payment areas
Same release and payment basis · bars start at $0
Utah · This locality
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.
Unavailable
No comparable rate is available in this setting.
Other payment areas listed in Utah 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
Alabama
Alabama · 42226
Office
Unavailable
Facility
$757.31
No comparable office rate is available.
Arkansas
Arkansas · 42226
Office
Unavailable
Facility
$747.63
No comparable office rate is available.
Arizona
Arizona · 42226
Office
Unavailable
Facility
$813.71
No comparable office rate is available.
Bakersfield
California · 42226
Office
Unavailable
Facility
$864.96
No comparable office rate is available.
Chico
California · 42226
Office
Unavailable
Facility
$860.70
No comparable office rate is available.
El Centro
California · 42226
Office
Unavailable
Facility
$860.94
No comparable office rate is available.
Fresno
California · 42226
Office
Unavailable
Facility
$860.70
No comparable office rate is available.
Hanford-Corcoran
California · 42226
Office
Unavailable
Facility
$860.70
No comparable office rate is available.
Madera
California · 42226
Office
Unavailable
Facility
$860.70
No comparable office rate is available.
Merced
California · 42226
Office
Unavailable
Facility
$860.70
No comparable office rate is available.
Modesto
California · 42226
Office
Unavailable
Facility
$860.70
No comparable office rate is available.
Napa
California · 42226
Office
Unavailable
Facility
$974.41
No comparable office rate is available.
Oxnard-Thousand Oaks-Ventura
California · 42226
Office
Unavailable
Facility
$907.25
No comparable office rate is available.
Redding
California · 42226
Office
Unavailable
Facility
$860.70
No comparable office rate is available.
Rest Of California
California · 42226
Office
Unavailable
Facility
$860.70
No comparable office rate is available.
Riverside-San Bernardino-Ontario
California · 42226
Office
Unavailable
Facility
$876.60
No comparable office rate is available.
Sacramento-Roseville-Folsom
California · 42226
Office
Unavailable
Facility
$897.16
No comparable office rate is available.
Salinas
California · 42226
Office
Unavailable
Facility
$893.68
No comparable office rate is available.
San Diego-Chula Vista-Carlsbad
California · 42226
Office
Unavailable
Facility
$910.23
No comparable office rate is available.
San Francisco-Oakland-Berkeley (Marin Cnty)
California · 42226
Office
Unavailable
Facility
$1024.06
No comparable office rate is available.
San Francisco-Oakland-Berkeley (San Francisco/San Mateo/Alameda/Contra Costa Cnty)
California · 42226
Office
Unavailable
Facility
$1022.39
No comparable office rate is available.
San Jose-Sunnyvale-Santa Clara (San Benito Cnty)
California · 42226
Office
Unavailable
Facility
$1047.25
No comparable office rate is available.
San Jose-Sunnyvale-Santa Clara (Santa Clara Cnty)
California · 42226
Office
Unavailable
Facility
$1040.42
No comparable office rate is available.
San Luis Obispo-Paso Robles
California · 42226
Office
Unavailable
Facility
$879.99
No comparable office rate is available.
Santa Cruz-Watsonville
California · 42226
Office
Unavailable
Facility
$915.43
No comparable office rate is available.
Santa Maria-Santa Barbara
California · 42226
Office
Unavailable
Facility
$895.81
No comparable office rate is available.
Santa Rosa-Petaluma
California · 42226
Office
Unavailable
Facility
$924.29
No comparable office rate is available.
Stockton
California · 42226
Office
Unavailable
Facility
$860.70
No comparable office rate is available.
Vallejo
California · 42226
Office
Unavailable
Facility
$972.00
No comparable office rate is available.
Visalia
California · 42226
Office
Unavailable
Facility
$860.70
No comparable office rate is available.
Yuba City
California · 42226
Office
Unavailable
Facility
$860.70
No comparable office rate is available.
Colorado
Colorado · 42226
Office
Unavailable
Facility
$856.69
No comparable office rate is available.
Connecticut
Connecticut · 42226
Office
Unavailable
Facility
$886.28
No comparable office rate is available.
Delaware
Delaware · 42226
Office
Unavailable
Facility
$826.03
No comparable office rate is available.
Fort Lauderdale
Florida · 42226
Office
Unavailable
Facility
$880.19
No comparable office rate is available.
Rest Of Florida
Florida · 42226
Office
Unavailable
Facility
$839.65
No comparable office rate is available.
Atlanta
Georgia · 42226
Office
Unavailable
Facility
$852.75
No comparable office rate is available.
Rest Of Georgia
Georgia · 42226
Office
Unavailable
Facility
$795.67
No comparable office rate is available.
Hawaii, Guam
Hawaii · 42226
Office
Unavailable
Facility
$875.47
No comparable office rate is available.
Iowa
Iowa · 42226
Office
Unavailable
Facility
$766.95
No comparable office rate is available.
Idaho
Idaho · 42226
Office
Unavailable
Facility
$772.93
No comparable office rate is available.
East St. Louis
Illinois · 42226
Office
Unavailable
Facility
$848.59
No comparable office rate is available.
Rest Of Illinois
Illinois · 42226
Office
Unavailable
Facility
$823.31
No comparable office rate is available.
Suburban Chicago
Illinois · 42226
Office
Unavailable
Facility
$887.06
No comparable office rate is available.
Indiana
Indiana · 42226
Office
Unavailable
Facility
$776.71
No comparable office rate is available.
Kansas
Kansas · 42226
Office
Unavailable
Facility
$767.27
No comparable office rate is available.
Kentucky
Kentucky · 42226
Office
Unavailable
Facility
$780.72
No comparable office rate is available.
New Orleans
Louisiana · 42226
Office
Unavailable
Facility
$814.90
No comparable office rate is available.
Rest Of Louisiana
Louisiana · 42226
Office
Unavailable
Facility
$781.04
No comparable office rate is available.
Metropolitan Boston
Massachusetts · 42226
Office
Unavailable
Facility
$930.13
No comparable office rate is available.
Rest Of Massachusetts
Massachusetts · 42226
Office
Unavailable
Facility
$853.89
No comparable office rate is available.
Baltimore/Surr. Cntys
Maryland · 42226
Office
Unavailable
Facility
$884.46
No comparable office rate is available.
Rest Of Maryland
Maryland · 42226
Office
Unavailable
Facility
$839.42
No comparable office rate is available.
Rest Of Maine
Maine · 42226
Office
Unavailable
Facility
$780.24
No comparable office rate is available.
Southern Maine
Maine · 42226
Office
Unavailable
Facility
$812.53
No comparable office rate is available.
Detroit
Michigan · 42226
Office
Unavailable
Facility
$852.67
No comparable office rate is available.
Rest Of Michigan
Michigan · 42226
Office
Unavailable
Facility
$802.00
No comparable office rate is available.
Minnesota
Minnesota · 42226
Office
Unavailable
Facility
$813.13
No comparable office rate is available.
Metropolitan Kansas City
Missouri · 42226
Office
Unavailable
Facility
$806.20
No comparable office rate is available.
Metropolitan St. Louis
Missouri · 42226
Office
Unavailable
Facility
$813.26
No comparable office rate is available.
Rest Of Missouri
Missouri · 42226
Office
Unavailable
Facility
$771.51
No comparable office rate is available.
Mississippi
Mississippi · 42226
Office
Unavailable
Facility
$759.52
No comparable office rate is available.
Montana**
Montana · 42226
Office
Unavailable
Facility
$834.59
No comparable office rate is available.
North Carolina
North Carolina · 42226
Office
Unavailable
Facility
$786.91
No comparable office rate is available.
North Dakota**
North Dakota · 42226
Office
Unavailable
Facility
$805.52
No comparable office rate is available.
Nebraska
Nebraska · 42226
Office
Unavailable
Facility
$769.61
No comparable office rate is available.
New Hampshire
New Hampshire · 42226
Office
Unavailable
Facility
$846.94
No comparable office rate is available.
Northern Nj
New Jersey · 42226
Office
Unavailable
Facility
$931.03
No comparable office rate is available.
Rest Of New Jersey
New Jersey · 42226
Office
Unavailable
Facility
$894.20
No comparable office rate is available.
New Mexico
New Mexico · 42226
Office
Unavailable
Facility
$807.33
No comparable office rate is available.
Nevada**
Nevada · 42226
Office
Unavailable
Facility
$826.94
No comparable office rate is available.
Nyc Suburbs/Long Island
New York · 42226
Office
Unavailable
Facility
$983.12
No comparable office rate is available.
Poughkpsie/N Nyc Suburbs
New York · 42226
Office
Unavailable
Facility
$902.78
No comparable office rate is available.
Queens
New York · 42226
Office
Unavailable
Facility
$959.60
No comparable office rate is available.
Rest Of New York
New York · 42226
Office
Unavailable
Facility
$797.68
No comparable office rate is available.
Ohio
Ohio · 42226
Office
Unavailable
Facility
$796.06
No comparable office rate is available.
Oklahoma
Oklahoma · 42226
Office
Unavailable
Facility
$775.74
No comparable office rate is available.
Portland
Oregon · 42226
Office
Unavailable
Facility
$877.30
No comparable office rate is available.
Rest Of Oregon
Oregon · 42226
Office
Unavailable
Facility
$818.31
No comparable office rate is available.
Metropolitan Philadelphia
Pennsylvania · 42226
Office
Unavailable
Facility
$868.62
No comparable office rate is available.
Rest Of Pennsylvania
Pennsylvania · 42226
Office
Unavailable
Facility
$795.20
No comparable office rate is available.
Puerto Rico
Puerto Rico · 42226
Office
Unavailable
Facility
$838.89
No comparable office rate is available.
Rhode Island
Rhode Island · 42226
Office
Unavailable
Facility
$850.59
No comparable office rate is available.
South Carolina
South Carolina · 42226
Office
Unavailable
Facility
$793.23
No comparable office rate is available.
South Dakota**
South Dakota · 42226
Office
Unavailable
Facility
$802.09
No comparable office rate is available.
Tennessee
Tennessee · 42226
Office
Unavailable
Facility
$771.14
No comparable office rate is available.
Austin
Texas · 42226
Office
Unavailable
Facility
$855.78
No comparable office rate is available.
Beaumont
Texas · 42226
Office
Unavailable
Facility
$790.83
No comparable office rate is available.
Brazoria
Texas · 42226
Office
Unavailable
Facility
$822.55
No comparable office rate is available.
Dallas
Texas · 42226
Office
Unavailable
Facility
$828.96
No comparable office rate is available.
Fort Worth
Texas · 42226
Office
Unavailable
Facility
$825.11
No comparable office rate is available.
Galveston
Texas · 42226
Office
Unavailable
Facility
$825.80
No comparable office rate is available.
Houston
Texas · 42226
Office
Unavailable
Facility
$852.71
No comparable office rate is available.
Rest Of Texas
Texas · 42226
Office
Unavailable
Facility
$807.05
No comparable office rate is available.
Virginia
Virginia · 42226
Office
Unavailable
Facility
$812.63
No comparable office rate is available.
Virgin Islands
United States Virgin Islands · 42226
Office
Unavailable
Facility
$838.89
No comparable office rate is available.
Vermont
Vermont · 42226
Office
Unavailable
Facility
$805.95
No comparable office rate is available.
Rest Of Washington
Washington · 42226
Office
Unavailable
Facility
$851.11
No comparable office rate is available.
Seattle (King Cnty)
Washington · 42226
Office
Unavailable
Facility
$944.38
No comparable office rate is available.
Wisconsin
Wisconsin · 42226
Office
Unavailable
Facility
$781.87
No comparable office rate is available.
West Virginia
West Virginia · 42226
Office
Unavailable
Facility
$797.09
No comparable office rate is available.
Wyoming**
Wyoming · 42226
Office
Unavailable
Facility
$821.92
No comparable office rate is available.
See how rates vary across the country
42226 · 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?
Utah is a Medicare payment area. Our Census mapping connects it to 334 cities and communities in Utah, 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 42226 in Utah. This uses the base rate on this page, so the locality and release stay consistent.
Reference amount per service
$883.05
$802.77 × 110% = $883.05
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 42226 in Utah.
PPRRVU2026_Oct_nonQPP.csv
5,012
- Code
- 42226
- Physician work
- 10.09
- Practice expense
- 13.43
- Malpractice
- 1.47
GPCI2026.csv
104
- Locality
- Utah
- Physician work
- 1.000
- Practice expense
- 0.940
- Malpractice
- 0.898
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 10.09 | × 1.000 | 10.0900 |
| Practice expense | 13.43 | × 0.940 | 12.6242 |
| Malpractice | 1.47 | × 0.898 | 1.3201 |
| Total RVUs | 24.0343 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Utah$802.77
Open 42226 in the RVU calculator →
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 10.09 | 1 |
| Practice expense | 13.43 | 0.94 |
| Malpractice | 1.47 | 0.898 |
(10.09 × 1 + 13.43 × 0.94 + 1.47 × 0.898) × $33.4009 = $802.77
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
42226 · 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 | $802.77 | RVU26D |
| 2026-07-01 | Not available in this setting | $802.77 | RVU26C |
| 2026-04-01 | Not available in this setting | $802.77 | RVU26B |
| 2026-01-01 | Not available in this setting | $802.77 | RVU26A |
| 2025-10-01 | Not available in this setting | $848.59 | RVU25D |
| 2025-07-01 | Not available in this setting | $848.59 | RVU25C |
| 2025-04-01 | Not available in this setting | $848.59 | RVU25B |
| 2025-01-01 | Not available in this setting | $848.59 | RVU25A |
42226 billing questions
How is 42226 distinguished from 42227?
42226 describes palatal lengthening using an island flap. 42227 is the related lengthening procedure using a local flap; the operative report should support the flap method reported.
What documentation supports 42226?
Document the reason for lengthening, the island-flap technique, how the tissue was mobilized and used to lengthen the palate, and relevant prior cleft-palate repair or scarring.
Can modifier 50 be reported?
No. Modifier 50 is inappropriate for this palatal procedure.
How does the 90-day global period affect postoperative reporting?
The global period includes the day-before preoperative visit and 90 days of related postoperative care. Those related services are included in the surgical global package.
How are other same-session procedures paid?
Under the standard multiple procedure reduction, the highest-valued procedure is paid in full and other procedures are paid at 50%. An assistant at surgery may be paid, but co-surgeons and team surgery 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.
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
5,01242226,,Lengthening of palate,A,,10.09,13.43,NA,13.43,,1.47,24.99,24.99,0,090,0.09,0.81,0.10,2,0,2,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,01342227,,Lengthening of palate,A,,9.65,12.15,NA,12.15,,1.40,23.20,23.20,0,090,0.09,0.81,0.10,2,0,2,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,01442235,,Repair palate,A,,7.81,11.70,NA,11.70,,1.14,20.65,20.65,0,090,0.09,0.81,0.10,2,0,2,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,01542260,,Repair nose to lip fistula,A,,9.96,14.12,,6.17,,1.45,25.53,17.58,0,090,0.09,0.81,0.10,2,0,2,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
10104412,TX,15,GALVESTON,1.008,0.993,0.828
10204412,TX,18,HOUSTON,1.008,0.993,1.376
10304412,TX,99,REST OF TEXAS,1.000,0.949,0.903
10403502,UT,09,UTAH,1.000,0.940,0.898
10514512,VT,50,VERMONT,1.000,0.990,0.506
10611302,VA,00,VIRGINIA,1.000,0.983,0.706
10709202,VI,50,VIRGIN ISLANDS,1.000,1.011,0.985