$196.73–$210.97
42104 is for a more limited lesion excision without closure. Use 42120 when the documented work involves extensive lesion removal or substantial palate resection.
On this page
CMS RVU26D · Effective 2026-10-01
42120 Palate resection Medicare reimbursement rates in Missouri
Reports substantial surgical removal of palatal tissue or an extensive palate lesion, rather than a limited lesion excision or diagnostic biopsy. Compare 42120 office and facility rates across CMS payment localities in Missouri.
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 42120 in Missouri?
Missouri has 3 payment localities in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the 3 payment areas shown below, using the same CMS release.
Office / nonfacility
No supported rate
Facility setting
$845.90–$889.75
3 of 3 localities have a supported rate.
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.
Where 42120 pays more and less in Missouri
Otolaryngology surgery
About 42120: Extensive palate lesion resection
Reports substantial surgical removal of palatal tissue or an extensive palate lesion, rather than a limited lesion excision or diagnostic biopsy.
An otolaryngologist or oral and maxillofacial surgeon reports this service when surgery removes a substantial portion of the palate or requires extensive excision of a palatal lesion. It is typically performed in an operating room, often for a sizable tumor or other lesion whose extent calls for more than a localized excision. The resected tissue may be submitted for pathologic examination.
Choose this code based on the operative extent and tissue removed, not the lesion diagnosis alone. The operative report should describe the palatal site, lesion extent, amount of tissue resected, and surgical work performed; limited lesion excision belongs to the more specific excision codes when their criteria are met. Medicare assigns a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. For multiple procedures in one session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% reduction. Bilateral adjustment is inappropriate. Assistant-at-surgery payment may be available; co-surgeon payment requires supporting documentation, and team surgery is not permitted.
CMS billing rules for 42120
- 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 paid only with supporting documentation.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU11.56 · 42%
- Practice expense (office) RVU14.06 · 51%
- Malpractice RVU1.69 · 6%
327
Medicare services in 2024 · #3930 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.
42120 compared with similar codes
Office rates for Missouri, from the same CMS release.
$236.13–$252.79
42106 describes limited lesion excision with simple repair. It does not represent extensive palate resection.
$428.39–$456.15
42107 describes limited lesion excision with complex repair. Distinguish it from 42120 by the extent of tissue resected, not simply by the complexity of closure.
$136.08–$145.20
42100 is for obtaining a palatal biopsy specimen. It is not the code for definitive extensive removal of the palate or a lesion.
Compare 42120 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.
3 of 3 payment localities
Metropolitan Kansas City →
Office / nonfacility
Unavailable
Facility
$882.23
Metropolitan St. Louis →
Office / nonfacility
Unavailable
Facility
$889.75
Rest Of Missouri →
Office / nonfacility
Unavailable
Facility
$845.90
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.
42120 billing questions
How does this differ from codes 42104, 42106, and 42107?
Those codes describe more limited palatal lesion excisions, distinguished by closure. Use 42120 when the operative work is an extensive lesion resection or substantial palate resection, rather than choosing it solely because a lesion is present.
Does the diagnosis alone support reporting 42120?
No. The operative report should establish the extent of the resection and the palate tissue removed; a tumor diagnosis by itself does not distinguish an extensive resection from a limited excision.
Should modifier 50 be used for bilateral work?
No. CMS identifies bilateral adjustment as inappropriate for this code.
What happens when another procedure is performed in the same session?
Under the standard multiple-procedure rule, the highest-valued procedure is paid in full and other procedures are paid at 50% when performed in the same session.
Can an assistant or co-surgeon be reported?
Assistant-at-surgery payment may be available. Co-surgeon payment requires supporting documentation; team surgery is 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.
4,99542106,,Excision lesion mouth roof,A,,2.10,5.46,,2.12,,0.27,7.83,4.49,0,010,0.10,0.80,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,99642107,,Excision lesion mouth roof,A,,4.45,9.05,,4.08,,0.59,14.09,9.12,0,090,0.09,0.81,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,9974210F,,Ace/arb thxpy for 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
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