$302.39
42180 is limited to a palatal laceration under 2 cm. Select between these palate-repair codes from the complete descriptor and the documented operative service.
On this page
CMS RVU26D · Effective 2026-10-01
42180 Palate repair Medicare reimbursement rates in Iowa
Repair a palatal laceration measuring less than 2 cm, typically after oral trauma, when the clinician closes the wound rather than excising a lesion. Compare 42180 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 42180 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
$234.03
1 of 1 localities have a supported rate.
Payment area: Iowa
One mapped payment locality.
Facility setting
$155.18
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 42180: Palatal laceration repair under 2 cm
Repair a palatal laceration measuring less than 2 cm, typically after oral trauma, when the clinician closes the wound rather than excising a lesion.
This service covers closure of a short laceration of the palate, such as an acute traumatic wound involving palatal tissue. An otolaryngologist, oral and maxillofacial surgeon, or other qualified clinician may perform the repair in an operating room or another setting equipped for the procedure. The operative record should identify the injured palatal site, document a wound length under 2 cm, and describe the repair performed.
Report the code for the laceration repair itself, not for a biopsy or removal of a palatal lesion. The code has a 10-day global period, which includes related postoperative visits during that period. 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 multiple procedure reduction. Modifier 50 is inappropriate for this repair. Assistant-at-surgery payment requires documented medical necessity; co-surgeons and team surgery are not permitted.
CMS billing rules for 42180
- 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 RVU2.49 · 33%
- Practice expense (office) RVU4.78 · 63%
- Malpractice RVU0.36 · 5%
12
Medicare services in 2024 · #6148 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.
42180 compared with similar codes
Office rates for Iowa, from the same CMS release.
$137.88
42100 is for biopsy of the roof of the mouth. It applies when tissue is sampled for diagnosis, not when a laceration is closed.
$200.75
42104 addresses excision of a lesion of the palate. It is not the code for suturing a traumatic palatal laceration.
Compare 42180 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
$234.03
Facility
$155.18
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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 42180 in Iowa.
PPRRVU2026_Oct_nonQPP.csv
5,002
- Code
- 42180
- Physician work
- 2.49
- Practice expense
- 4.78
- Malpractice
- 0.36
GPCI2026.csv
53
- Locality
- Iowa
- Physician work
- 1.000
- Practice expense
- 0.915
- Malpractice
- 0.397
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 2.49 | × 1.000 | 2.4900 |
| Practice expense | 4.78 | × 0.915 | 4.3737 |
| Malpractice | 0.36 | × 0.397 | 0.1429 |
| Total RVUs | 7.0066 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Iowa$234.03
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 2.49 | 1 |
| Practice expense | 4.78 | 0.915 |
| Malpractice | 0.36 | 0.397 |
(2.49 × 1 + 4.78 × 0.915 + 0.36 × 0.397) × $33.4009 = $234.03
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 2.49 | 1 |
| Practice expense | 2.2 | 0.915 |
| Malpractice | 0.36 | 0.397 |
(2.49 × 1 + 2.2 × 0.915 + 0.36 × 0.397) × $33.4009 = $155.18
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.
42180 billing questions
How does this code differ from 42182?
Use 42180 for a palatal laceration under 2 cm. Check the complete descriptor and documented operative work before selecting 42182 for a different palate repair.
Can a palatal biopsy or lesion excision be reported as this repair?
No. This code describes closure of a laceration; biopsy and lesion excision are different services, even when performed on the palate.
Are related postoperative visits separately reported?
Related postoperative visits during the 10-day global period are included in the procedure's global service.
Should modifier 50 be used for a wound involving both sides of the palate?
No. Modifier 50 is inappropriate for this code; document the laceration and repair performed.
When is an assistant at surgery payable?
Only when the record documents medical necessity for the assistant. 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.
4,99942140,,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
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
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