$378.77
Choose 41800 for a collection arising from dentoalveolar structures. Code 42000 is for drainage involving the palate or uvula.
On this page
CMS RVU26D · Effective 2026-10-01
42000 Oral lesion drainage Medicare reimbursement rates in Delaware
Drainage of an abscess, cyst, or hematoma involving the palate or uvula, reported when the clinician opens and evacuates the collection. Compare 42000 office and facility rates across CMS payment localities in Delaware.
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.
What does Medicare pay for 42000 in Delaware?
Delaware has 1 payment locality in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the payment area shown below, using the same CMS release.
Office / nonfacility
$158.25
1 of 1 localities have a supported rate.
Payment area: Delaware
One mapped payment locality.
Facility setting
$98.18
1 of 1 localities have a supported rate.
Payment area: Delaware
One mapped payment locality.
These are locality ranges, not averages or address-specific quotes. A facility-setting amount covers the physician service; it does not include a hospital’s separate bill. Choose a locality below to inspect its calculation, compare other payment areas, or price a percentage of Medicare.
Oral surgery
About 42000: Palate or uvula lesion drainage
Drainage of an abscess, cyst, or hematoma involving the palate or uvula, reported when the clinician opens and evacuates the collection.
This service involves opening and draining a collection in the roof of the mouth or uvula, such as a palatal abscess or cyst. It may be performed by an oral and maxillofacial surgeon, dentist, or other qualified clinician in an office or facility setting. The code describes drainage at these specific sites, rather than a collection arising from the teeth or floor of the mouth.
Report it when the clinician actually drains the palate or uvula lesion. The record should identify the site and lesion and document the drainage performed. This minor procedure has a 10-day global period, including related postoperative visits during that period. When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and others are subject to the standard 50% reduction. Modifier 50 is inappropriate for this service. Assistant-at-surgery payment requires documented medical necessity; co-surgeons and team surgery are not permitted.
CMS billing rules for 42000
- 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
- Assistant at surgery is paid only with documentation of medical necessity.
- Co-surgeons
- Co-surgeons not permitted.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU1.25 · 26%
- Practice expense (office) RVU3.36 · 70%
- Malpractice RVU0.18 · 4%
43
Medicare services in 2024 · #5450 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.
42000 compared with similar codes
Office rates for Delaware, from the same CMS release.
$148.39
42100 represents biopsy of the palate or uvula for tissue diagnosis. Use 42000 when the service performed is drainage of a collection at those sites.
Compare 42000 by payment locality
Find the payment area for your service address, then open its rate page for calculation inputs, release history and the percentage-of-Medicare tool. A city may cross payment-area boundaries; the ZIP lookup above helps resolve the location.
1 of 1 payment localities
Delaware →
Office / nonfacility
$158.25
Facility
$98.18
Need rates for a whole code list?
Fee-sheet and API access are in early access. Tell us which codes and locations your team needs.
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 42000 in Delaware.
PPRRVU2026_Oct_nonQPP.csv
4,990
- Code
- 42000
- Physician work
- 1.25
- Practice expense
- 3.36
- Malpractice
- 0.18
GPCI2026.csv
40
- Locality
- Delaware
- Physician work
- 1.005
- Practice expense
- 0.988
- Malpractice
- 0.899
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 1.25 | × 1.005 | 1.2562 |
| Practice expense | 3.36 | × 0.988 | 3.3197 |
| Malpractice | 0.18 | × 0.899 | 0.1618 |
| Total RVUs | 4.7377 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Delaware$158.25
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 1.25 | 1.005 |
| Practice expense | 3.36 | 0.988 |
| Malpractice | 0.18 | 0.899 |
(1.25 × 1.005 + 3.36 × 0.988 + 0.18 × 0.899) × $33.4009 = $158.25
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 1.25 | 1.005 |
| Practice expense | 1.54 | 0.988 |
| Malpractice | 0.18 | 0.899 |
(1.25 × 1.005 + 1.54 × 0.988 + 0.18 × 0.899) × $33.4009 = $98.18
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.
42000 billing questions
How does this differ from drainage of a floor-of-mouth collection?
Use 42000 for a collection involving the palate or uvula. A collection in the floor of the mouth is coded to the site-specific drainage service, such as 42010.
Can this code be used for a tooth-related abscess?
No. A collection arising from dentoalveolar structures is distinct from drainage involving the palate or uvula; 41800 covers the dentoalveolar site.
Is a related postoperative visit separately reported during the global period?
Related postoperative visits for 10 days are included in the procedure's global period.
Should modifier 50 be appended for drainage on both sides?
No. Modifier 50 is inappropriate for this service.
When can an assistant-at-surgery claim be paid?
Assistant-at-surgery payment is allowed only when medical necessity is documented. Co-surgeons and team surgery are not permitted.
How are other procedures in the same session paid?
Under the standard multiple procedure reduction, the highest-valued procedure is paid in full and other procedures are paid at 50%.
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.
4,9874194F,,Pt rcv >=10mg daily predniso,M,,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
4,9884195F,,Pt rcvng anti-rheum thxpy ra,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
4,9894196F,,Ptnot rcvng anti-rhm thxpyra,M,,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
4,99042000,,Drainage mouth roof lesion,A,,1.25,3.36,,1.54,,0.18,4.79,2.97,0,010,0.10,0.80,0.10,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,9914200F,,External beam to prost only,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
4,9924201F,,Extrnl beam other than prost,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
4,99342100,,Biopsy roof of mouth,A,,1.33,2.98,,1.53,,0.18,4.49,3.04,0,010,0.10,0.80,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3704112,CO,01,COLORADO,1.012,1.064,0.781
3813102,CT,00,CONNECTICUT,1.020,1.077,1.210
3912202,DC,01,DC + MD/VA SUBURBS,1.054,1.178,1.113
4012102,DE,01,DELAWARE,1.005,0.988,0.899
4109102,FL,03,FORT LAUDERDALE,1.000,1.013,1.808
4209102,FL,04,MIAMI,1.000,1.041,2.529
4309102,FL,99,REST OF FLORIDA,1.000,0.956,1.503