$169.93
Choose 42280 for preparation of a palate mold. Choose 42281 when the palatal prosthesis is inserted.
On this page
CMS RVU26D · Effective 2026-10-01
42281 Palate prosthesis Medicare reimbursement rates in Oklahoma
Report palatal prosthesis insertion when a clinician places an obturator or similar device to address a palatal defect or oral-nasal communication. Compare 42281 office and facility rates across CMS payment localities in Oklahoma.
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 42281 in Oklahoma?
Oklahoma 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
$221.50
1 of 1 localities have a supported rate.
Payment area: Oklahoma
One mapped payment locality.
Facility setting
$143.06
1 of 1 localities have a supported rate.
Payment area: Oklahoma
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 42281: Palatal prosthesis insertion
Report palatal prosthesis insertion when a clinician places an obturator or similar device to address a palatal defect or oral-nasal communication.
This service covers placing a palatal prosthesis, such as an obturator, to help close a defect between the mouth and nasal cavity or support palatal function. It may be used for an acquired defect after surgery or trauma, or for a congenital palatal opening. An oral and maxillofacial surgeon, otolaryngologist, or other clinician involved in the patient’s palatal care may perform the insertion in a hospital or outpatient setting.
Report 42281 for insertion, not for palate reconstruction with the patient’s tissues. The record should identify the defect or functional problem, the prosthesis placed, and the insertion and fit assessment. 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% reduction. Modifier 50 is not appropriate for this service. Assistant-at-surgery payment requires documentation of medical necessity; co-surgeons and team surgery are not permitted.
CMS billing rules for 42281
- 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 RVU1.93 · 27%
- Practice expense (office) RVU5.03 · 70%
- Malpractice RVU0.27 · 4%
43
Medicare services in 2024 · #5451 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.
42281 compared with similar codes
Office rates for Oklahoma, from the same CMS release.
No office rate
42235 describes surgical repair of the palate. 42281 describes placement of a prosthesis to address a defect.
No office rate
42200 is for cleft palate reconstruction; 42281 is for insertion of a palatal prosthesis rather than tissue reconstruction.
Compare 42281 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
Oklahoma →
Office / nonfacility
$221.50
Facility
$143.06
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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 42281 in Oklahoma.
PPRRVU2026_Oct_nonQPP.csv
5,017
- Code
- 42281
- Physician work
- 1.93
- Practice expense
- 5.03
- Malpractice
- 0.27
GPCI2026.csv
86
- Locality
- Oklahoma
- Physician work
- 1.000
- Practice expense
- 0.893
- Malpractice
- 0.777
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 1.93 | × 1.000 | 1.9300 |
| Practice expense | 5.03 | × 0.893 | 4.4918 |
| Malpractice | 0.27 | × 0.777 | 0.2098 |
| Total RVUs | 6.6316 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Oklahoma$221.50
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 1.93 | 1 |
| Practice expense | 5.03 | 0.893 |
| Malpractice | 0.27 | 0.777 |
(1.93 × 1 + 5.03 × 0.893 + 0.27 × 0.777) × $33.4009 = $221.50
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 1.93 | 1 |
| Practice expense | 2.4 | 0.893 |
| Malpractice | 0.27 | 0.777 |
(1.93 × 1 + 2.4 × 0.893 + 0.27 × 0.777) × $33.4009 = $143.06
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.
42281 billing questions
How is 42281 different from 42280?
42281 reports insertion of the palatal prosthesis. 42280 addresses preparation of a palate mold.
Is this code for surgical repair of a cleft palate?
No. 42281 describes prosthesis placement; cleft palate reconstruction codes describe operative repair using tissue.
What documentation supports 42281?
Document the palatal defect or functional problem, the prosthesis placed, and the insertion and fit assessment.
Are related postoperative visits separately payable?
Related postoperative visits within the 10-day global period are included in the procedure.
Can modifier 50 be appended?
No. The service is not reported as a bilateral procedure, so modifier 50 is inappropriate.
When may an assistant-at-surgery be reported?
Assistant-at-surgery payment is allowed only when the record documents 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.
5,01442235,,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
5,02042305,,Drainage of salivary gland,A,,6.15,4.47,NA,4.47,,0.90,11.52,11.52,0,090,0.09,0.81,0.10,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
8311502,NC,00,NORTH CAROLINA,1.000,0.933,0.639
8403302,ND,01,NORTH DAKOTA**,1.000,1.000,0.406
8515202,OH,00,OHIO,1.000,0.913,1.008
8604312,OK,00,OKLAHOMA,1.000,0.893,0.777
8702302,OR,01,PORTLAND,1.016,1.111,0.744
8802302,OR,99,REST OF OREGON,1.000,0.996,0.703
8912502,PA,01,METROPOLITAN PHILADELPHIA,1.018,1.041,1.193