$137.88
42100 is for biopsy of the roof of the mouth. Report 42160 when the lesion is treated by destruction rather than sampled for examination.
On this page
CMS RVU26D · Effective 2026-10-01
42160 Palate lesion treatment Medicare reimbursement rates in Iowa
Reports destruction of a lesion on the palate or uvula, such as treatment using laser or cautery rather than biopsy or excision. Compare 42160 office and facility rates across CMS payment localities in Iowa.
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 42160 in Iowa?
Iowa 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
$214.01
1 of 1 localities have a supported rate.
Payment area: Iowa
One mapped payment locality.
Facility setting
$119.27
1 of 1 localities have a supported rate.
Payment area: Iowa
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 42160: Destruction of palate or uvula lesion
Reports destruction of a lesion on the palate or uvula, such as treatment using laser or cautery rather than biopsy or excision.
This service destroys a lesion on the roof of the mouth or uvula, using a method such as laser or cautery. Otolaryngologists and oral surgeons may perform it in an office or operating room when the treatment plan is to destroy the lesion rather than remove tissue for examination or excise it surgically. The site and treatment method distinguish this service from biopsy and excision codes for the same area.
Document the lesion’s location and the destruction 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 service. Assistant-at-surgery payment requires documented medical necessity; co-surgeons and team surgery are not permitted.
CMS billing rules for 42160
- 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 RVU1.80 · 26%
- Practice expense (office) RVU4.94 · 71%
- Malpractice RVU0.22 · 3%
99
Medicare services in 2024 · #4891 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.
42160 compared with similar codes
Office rates for Iowa, from the same CMS release.
$200.75
42104 describes excision of a palate lesion. Use 42160 for a destruction method such as laser or cautery, not surgical removal.
$240.59
42106 is another palate-lesion excision option. The key distinction is excision of tissue versus destruction of the lesion with 42160.
Compare 42160 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
Iowa →
Office / nonfacility
$214.01
Facility
$119.27
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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 42160 in Iowa.
PPRRVU2026_Oct_nonQPP.csv
5,001
- Code
- 42160
- Physician work
- 1.80
- Practice expense
- 4.94
- Malpractice
- 0.22
GPCI2026.csv
53
- Locality
- Iowa
- Physician work
- 1.000
- Practice expense
- 0.915
- Malpractice
- 0.397
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 1.80 | × 1.000 | 1.8000 |
| Practice expense | 4.94 | × 0.915 | 4.5201 |
| Malpractice | 0.22 | × 0.397 | 0.0873 |
| Total RVUs | 6.4074 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Iowa$214.01
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 1.8 | 1 |
| Practice expense | 4.94 | 0.915 |
| Malpractice | 0.22 | 0.397 |
(1.8 × 1 + 4.94 × 0.915 + 0.22 × 0.397) × $33.4009 = $214.01
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 1.8 | 1 |
| Practice expense | 1.84 | 0.915 |
| Malpractice | 0.22 | 0.397 |
(1.8 × 1 + 1.84 × 0.915 + 0.22 × 0.397) × $33.4009 = $119.27
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.
42160 billing questions
When should this code be chosen over a palate biopsy code?
Use this code when the lesion is destroyed, for example with laser or cautery. A biopsy code describes tissue sampling for examination.
How does this differ from palate lesion excision?
This code represents destruction of the lesion. Choose an excision code when the service removes the lesion surgically rather than destroying it.
Are related postoperative visits separately reported?
Related postoperative visits during the 10-day global period are included in this procedure’s payment.
How are other procedures performed in the same session paid?
The highest-valued procedure is paid in full; other procedures in the session are subject to the standard multiple-procedure reduction.
Can modifier 50 or an assistant-at-surgery claim be used?
Modifier 50 is inappropriate for this service. Assistant-at-surgery payment requires documentation of medical necessity.
Can co-surgeons or a surgical team report this service?
Co-surgeons and team surgery are not permitted 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.
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
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
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
5607202,LA,01,NEW ORLEANS,1.000,0.941,1.136