Billing code 42120: Palate resectionMedicare rate & RVUs in Oregon
Reports substantial surgical removal of palatal tissue or an extensive palate lesion, rather than a limited lesion excision or diagnostic biopsy.
CMS doesn’t publish an office rate for 42120 in Oregon.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
On this page 9 sections
What 42120 covers
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.
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.
Where 42120 pays more and less in Oregon
| Payment locality | Office | Facility |
|---|---|---|
| Portland | Unavailable | $956.03 |
| Rest Of Oregon | Unavailable | $893.54 |
How the 42120 rate is calculated
Each of 42120’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.
How the rate is built · 42120
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 11.56Practice expense 14.06Malpractice 1.69
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 42120
42120 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 42120
Palate resection
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 090 | Major surgery: the day before, the day of, and 90 days after are included. |
| Multiple procedures | 2 | Standard reduction: highest-valued procedure at 100%, others at 50%. |
| Bilateral (modifier 50) | 0 | The 150% bilateral adjustment doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 2 | Paid. |
| Co-surgeons (62) | 1 | Permitted with supporting documentation. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
| Split (54/55/56) | 0.09/0.81/0.10 | Share of the payment for pre-op, the procedure itself, and post-op care. |
Global surgery period · 42120
Palate resection
90-day global period ends
Dec 30, 2026
Covers Sep 30, 2026 through Dec 30, 2026 (92 days, including the day before surgery).
Visit on Oct 31, 2026
Day 30 of the 90-day post-op period: related follow-up care is included in the surgical payment.
Pre-op dayGlobal period
What modifiers do to the payment
Modifier 51 · payment effect
With and without the modifier
42120 without 51 · national facility
$912.18
Palate resection
42120-51 · Second procedure: 50%
$456.09
When this isn’t the highest-valued procedure in the session, Medicare pays 50% of its fee schedule amount (the highest is paid at 100%).
42120 compared with similar codes
Compare codes
42120 vs 42104 vs 42106 vs 42107 vs 42100: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 42104Palatal excision
- 42104 is for a more limited lesion excision without closure. Use 42120 when the documented work involves extensive lesion removal or substantial palate resection.
- 42106Palate excision
- 42106 describes limited lesion excision with simple repair. It does not represent extensive palate resection.
- 42107Palatal lesion excision
- 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.
- 42100Palate biopsy
- 42100 is for obtaining a palatal biopsy specimen. It is not the code for definitive extensive removal of the palate or a lesion.
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 indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.
CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027
Show the CMS file lines behind this rate
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