$237.01
Both codes repair palatal lacerations; 42180 is for wounds under 2 cm, while 42182 is for wounds measuring 2 cm or greater.
On this page
CMS RVU26D · Effective 2026-10-01
42182 Palate repair Medicare reimbursement rates in Indiana
Repair a palatal laceration measuring 2 cm or greater, typically after oral or facial trauma requiring surgical closure. Compare 42182 office and facility rates across CMS payment localities in Indiana.
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 42182 in Indiana?
Indiana 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
$306.22
1 of 1 localities have a supported rate.
Payment area: Indiana
One mapped payment locality.
Facility setting
$212.40
1 of 1 localities have a supported rate.
Payment area: Indiana
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 42182: Palatal laceration repair, 2 cm or greater
Repair a palatal laceration measuring 2 cm or greater, typically after oral or facial trauma requiring surgical closure.
CPT 42182 describes surgical closure of a palate laceration that measures at least 2 cm. The injury may involve the hard or soft palate. Otolaryngologists, oral and maxillofacial surgeons, and other surgeons who manage oral trauma may perform the repair in a hospital or other surgical setting. This is for closing a traumatic wound, not for removing a palatal lesion or performing planned reconstruction.
Report the code when the documented wound length meets the 2 cm threshold; record the injury site, measured length, and repair performed. The code has a 10-day global period, so related postoperative visits during that period are included. When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% multiple-procedure reduction. Modifier 50 is inappropriate for this code. An assistant at surgery is paid only when medical necessity is documented; co-surgeons and team surgery are not permitted.
CMS billing rules for 42182
- 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 RVU3.77 · 38%
- Practice expense (office) RVU5.54 · 56%
- Malpractice RVU0.54 · 5%
17
Medicare services in 2024 · #6007 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.
42182 compared with similar codes
Office rates for Indiana, from the same CMS release.
No office rate
42145 describes a palatopharyngeal or uvular procedure, rather than closure of an acute palatal laceration.
No office rate
42120 is used to remove a palatal lesion; 42182 closes a traumatic laceration.
$290.92
40831 applies to a laceration of the oral vestibule. Use 42182 when the repaired wound is on the palate and meets its length threshold.
Compare 42182 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
Indiana →
Office / nonfacility
$306.22
Facility
$212.40
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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 42182 in Indiana.
PPRRVU2026_Oct_nonQPP.csv
5,003
- Code
- 42182
- Physician work
- 3.77
- Practice expense
- 5.54
- Malpractice
- 0.54
GPCI2026.csv
52
- Locality
- Indiana
- Physician work
- 1.000
- Practice expense
- 0.927
- Malpractice
- 0.486
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 3.77 | × 1.000 | 3.7700 |
| Practice expense | 5.54 | × 0.927 | 5.1356 |
| Malpractice | 0.54 | × 0.486 | 0.2624 |
| Total RVUs | 9.1680 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Indiana$306.22
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 3.77 | 1 |
| Practice expense | 5.54 | 0.927 |
| Malpractice | 0.54 | 0.486 |
(3.77 × 1 + 5.54 × 0.927 + 0.54 × 0.486) × $33.4009 = $306.22
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 3.77 | 1 |
| Practice expense | 2.51 | 0.927 |
| Malpractice | 0.54 | 0.486 |
(3.77 × 1 + 2.51 × 0.927 + 0.54 × 0.486) × $33.4009 = $212.40
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.
42182 billing questions
How do I choose between 42182 and 42180?
Use 42182 for a palatal laceration measuring 2 cm or greater. Code 42180 is for a laceration under 2 cm.
Does the 10-day global period include follow-up visits?
Related postoperative visits during the 10-day global period are included in the procedure.
Can modifier 50 be reported?
No. The bilateral adjustment does not apply, and modifier 50 is inappropriate for this code.
When can an assistant-at-surgery claim be paid?
Payment for an assistant at surgery requires documentation of medical necessity. Co-surgeons and team surgery are not permitted.
How are other procedures in the same session paid?
The highest-valued procedure is paid in full; other procedures in the same session are subject to the standard 50% multiple-procedure reduction.
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.
5,00042145,,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
5,00242180,,Repair lac palate<2 cm,A,,2.49,4.78,,2.20,,0.36,7.63,5.05,0,010,0.10,0.80,0.10,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,00342182,,Repair palate,A,,3.77,5.54,,2.51,,0.54,9.85,6.82,0,010,0.10,0.80,0.10,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,00442200,,Reconstruct cleft palate,A,,12.22,10.74,NA,10.74,,2.27,25.23,25.23,0,090,0.09,0.81,0.10,2,0,2,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,00542205,,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
4906102,IL,12,EAST ST. LOUIS,1.000,0.920,2.014
5006102,IL,15,SUBURBAN CHICAGO,1.007,1.027,1.772
5106102,IL,99,REST OF ILLINOIS,1.000,0.913,1.563
5208102,IN,00,INDIANA,1.000,0.927,0.486
5305102,IA,00,IOWA,1.000,0.915,0.397
5405202,KS,00,KANSAS,1.000,0.904,0.504
5515102,KY,00,KENTUCKY,1.000,0.889,0.915