$218.07–$233.44
42280 covers preparing the palate mold. Use 42281 for insertion of a palate prosthesis.
On this page
CMS RVU26D · Effective 2026-10-01
42280 Palate mold Medicare reimbursement rates in Missouri
Preparation of a custom palate mold for prosthetic management of a palatal defect, reported for mold preparation rather than prosthesis insertion. Compare 42280 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 42280 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
$167.47–$179.01
3 of 3 localities have a supported rate.
Facility setting
$92.61–$96.34
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 42280 pays more and less in Missouri
3 payment localities
$167.47 to $179.01
Palatal prosthetic care
About 42280: Custom palate mold preparation
Preparation of a custom palate mold for prosthetic management of a palatal defect, reported for mold preparation rather than prosthesis insertion.
This service prepares a custom mold shaped to the patient’s palate for prosthetic care of a palatal defect, such as one associated with a cleft. The mold is used in planning or making a palate prosthesis; this code describes preparation, not placement of the finished prosthesis. It is most relevant to care involving a prosthodontist or another clinician experienced in palatal prosthetics, often in an office setting.
Report the service when the record supports preparation of the patient-specific palate mold, rather than a palatal reconstruction or insertion of a prosthesis. Documentation should identify the defect being managed and the mold-preparation work performed. CMS assigns 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. Assistant-at-surgery payment requires documented medical necessity; co-surgeons and team surgery are not permitted.
CMS billing rules for 42280
- 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 RVU1.55 · 28%
- Practice expense (office) RVU3.77 · 68%
- Malpractice RVU0.22 · 4%
24
Medicare services in 2024 · #5813 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.
42280 compared with similar codes
Office rates for Missouri, from the same CMS release.
No office rate
42200 describes surgical cleft-palate reconstruction. 42280 is for mold preparation in prosthetic care, not operative repair.
No office rate
42210 is a palatal reconstruction procedure. Choose 42280 when the service is preparation of a custom palate mold rather than reconstruction.
Compare 42280 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
$177.19
Facility
$95.65
Metropolitan St. Louis →
Office / nonfacility
$179.01
Facility
$96.34
Rest Of Missouri →
Office / nonfacility
$167.47
Facility
$92.61
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42280 billing questions
When should this code be used instead of 42281?
Use 42280 for preparation of the custom palate mold. Code 42281 describes insertion of a palate prosthesis, not mold preparation.
Does this code describe a palate repair?
No. It represents mold preparation for prosthetic care; codes such as 42200 describe surgical reconstruction of the palate.
Are related postoperative visits separately reported?
Related postoperative visits during the 10-day global period are included in this service.
Can modifier 50 be appended?
No. CMS identifies bilateral adjustment as inappropriate for this code.
How are other procedures in the same session paid?
The highest-valued procedure is paid in full; other procedures in that session are subject to the standard multiple-procedure reduction.
Can an assistant or co-surgeon be reported?
Assistant-at-surgery payment requires documentation of medical necessity. Co-surgeons and team surgery are 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.
5,01342227,,Lengthening of palate,A,,9.65,12.15,NA,12.15,,1.40,23.20,23.20,0,090,0.09,0.81,0.10,2,0,2,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,01442235,,Repair palate,A,,7.81,11.70,NA,11.70,,1.14,20.65,20.65,0,090,0.09,0.81,0.10,2,0,2,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,01542260,,Repair nose to lip fistula,A,,9.96,14.12,,6.17,,1.45,25.53,17.58,0,090,0.09,0.81,0.10,2,0,2,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,01642280,,Preparation palate mold,A,,1.55,3.77,,1.17,,0.22,5.54,2.94,0,010,0.10,0.80,0.10,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,01742281,,Insertion palate prosthesis,A,,1.93,5.03,,2.40,,0.27,7.23,4.60,0,010,0.10,0.80,0.10,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,01842299,,Unlisted px palate uvula,C,,0.00,0.00,,0.00,,0.00,0.00,0.00,0,YYY,0.00,0.00,0.00,2,0,2,1,1,9,,33.4009,09,0,99,0.00,0.00,0.00
5,01942300,,Drainage of salivary gland,A,,1.93,4.23,,2.05,,0.26,6.42,4.24,0,010,0.10,0.80,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00