No office rate
Both codes describe palatal lengthening, but 42226 uses an island flap and 42227 uses a local flap. Use the flap technique documented in the operative report.
On this page
CMS RVU26D · Effective 2026-10-01
42226 Palate lengthening Medicare reimbursement rates in New Mexico
Reports surgical palatal lengthening using an island flap, commonly to address a short palate and persistent velopharyngeal dysfunction after cleft-palate repair. Compare 42226 office and facility rates across CMS payment localities in New Mexico.
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 42226 in New Mexico?
New Mexico 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
No supported rate
Facility setting
$807.33
1 of 1 localities have a supported rate.
Payment area: New Mexico
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.
Cleft palate surgery
About 42226: Island-flap palatal lengthening
Reports surgical palatal lengthening using an island flap, commonly to address a short palate and persistent velopharyngeal dysfunction after cleft-palate repair.
This operation lengthens the palate by mobilizing an island flap of tissue while preserving its blood supply, then positioning it to add palatal reach. It may be performed for a short or scarred palate associated with velopharyngeal dysfunction, including in a patient with a history of cleft-palate repair. Plastic surgeons, otolaryngologists, and oral and maxillofacial surgeons with cleft or craniofacial expertise typically perform the procedure in an operating room.
Report 42226 when the operative work uses the island-flap approach; distinguish it from lengthening with a local flap or another secondary palatoplasty technique. The operative report should identify the indication, flap technique, tissue mobilization, and reconstructive work performed. CMS assigns a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and others at 50%. Modifier 50 is inappropriate for this palatal procedure. An assistant at surgery may be paid; co-surgeons and team surgery are not permitted.
CMS billing rules for 42226
- 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 not permitted.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU10.09 · 40%
- Practice expense (office) RVU13.43 · 54%
- Malpractice RVU1.47 · 6%
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.
42226 compared with similar codes
Office rates for New Mexico, from the same CMS release.
No office rate
42220 describes secondary palatoplasty to lengthen the palate. Choose 42226 when the documented lengthening is performed with an island flap.
No office rate
42225 describes secondary palatoplasty lengthening with additional cleft-palate repair work. 42226 identifies lengthening performed with an island flap.
Compare 42226 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
New Mexico →
Office / nonfacility
Unavailable
Facility
$807.33
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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 42226 in New Mexico.
PPRRVU2026_Oct_nonQPP.csv
5,012
- Code
- 42226
- Physician work
- 10.09
- Practice expense
- 13.43
- Malpractice
- 1.47
GPCI2026.csv
77
- Locality
- New Mexico
- Physician work
- 1.000
- Practice expense
- 0.917
- Malpractice
- 1.201
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 10.09 | × 1.000 | 10.0900 |
| Practice expense | 13.43 | × 0.917 | 12.3153 |
| Malpractice | 1.47 | × 1.201 | 1.7655 |
| Total RVUs | 24.1708 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, New Mexico$807.33
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 10.09 | 1 |
| Practice expense | 13.43 | 0.917 |
| Malpractice | 1.47 | 1.201 |
(10.09 × 1 + 13.43 × 0.917 + 1.47 × 1.201) × $33.4009 = $807.33
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.
42226 billing questions
How is 42226 distinguished from 42227?
42226 describes palatal lengthening using an island flap. 42227 is the related lengthening procedure using a local flap; the operative report should support the flap method reported.
What documentation supports 42226?
Document the reason for lengthening, the island-flap technique, how the tissue was mobilized and used to lengthen the palate, and relevant prior cleft-palate repair or scarring.
Can modifier 50 be reported?
No. Modifier 50 is inappropriate for this palatal procedure.
How does the 90-day global period affect postoperative reporting?
The global period includes the day-before preoperative visit and 90 days of related postoperative care. Those related services are included in the surgical global package.
How are other same-session procedures paid?
Under the standard multiple procedure reduction, the highest-valued procedure is paid in full and other procedures are paid at 50%. An assistant at surgery may be paid, but 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.
5,0094221F,,Diuretic 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
5,01042220,,Reconstruct cleft palate,A,,6.98,7.87,NA,7.87,,1.30,16.15,16.15,0,090,0.09,0.81,0.10,2,0,2,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,01142225,,Reconstruct cleft palate,A,,9.53,17.73,NA,17.73,,1.76,29.02,29.02,0,090,0.09,0.81,0.10,2,0,2,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,01242226,,Lengthening of palate,A,,10.09,13.43,NA,13.43,,1.47,24.99,24.99,0,090,0.09,0.81,0.10,2,0,2,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,01342227,,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
7414312,NH,40,NEW HAMPSHIRE,1.000,1.041,0.875
7512402,NJ,01,NORTHERN NJ,1.063,1.160,1.068
7612402,NJ,99,REST OF NEW JERSEY,1.040,1.092,1.097
7704212,NM,05,NEW MEXICO,1.000,0.917,1.201
7813202,NY,01,MANHATTAN,1.064,1.162,1.586
7913202,NY,02,NYC SUBURBS/LONG ISLAND,1.064,1.189,1.857
8013202,NY,03,POUGHKPSIE/N NYC SUBURBS,1.045,1.095,1.210