Billing code 42210: Cleft palate repairMedicare rate & RVUs in Oregon
Reports cleft palate reconstruction that closes an alveolar ridge defect and includes bone grafting to the ridge as part of the repair.
CMS doesn’t publish an office rate for 42210 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 42210 covers
This service reconstructs a cleft involving the palate and alveolar ridge, with bone grafting included in the operative repair. Plastic and craniofacial surgeons, oral and maxillofacial surgeons, or other surgeons experienced in cleft reconstruction typically perform it in an operating room. A common clinical situation is grafting an alveolar cleft to restore continuity of the ridge as part of staged cleft care.
Select this code when the operative record supports both alveolar ridge closure and bone grafting to that ridge; document the defect, graft site and reconstructive work. CMS assigns a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. For procedures in the same session, the highest-valued procedure is paid in full and others are subject to the standard 50% multiple-procedure reduction. Modifier 50 is inappropriate. Assistant-at-surgery payment may be available; co-surgeon and team-surgery billing are not permitted under the CMS rules for this code.
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 42210 pays more and less in Oregon
| Payment locality | Office | Facility |
|---|---|---|
| Portland | Unavailable | $998.17 |
| Rest Of Oregon | Unavailable | $941.75 |
How the 42210 rate is calculated
Each of 42210’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 · 42210
RVUs × geographic indexes × conversion factor
Work14.65
14.65 RVUs× 1.000 GPCI
Practice expense11.68
11.68 RVUs× 1.000 GPCI
Malpractice2.72
2.72 RVUs× 1.000 GPCI
Adjusted RVUs
29.0500
Conversion factor
$33.4009
Medicare rate
$970.30
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 42210
42210 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 42210
Cleft palate repair
| 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) | 0 | Not permitted. |
| 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 · 42210
Cleft palate repair
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
42210 without 51 · national facility
$970.30
Cleft palate repair
42210-51 · Second procedure: 50%
$485.15
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%).
42210 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 42205Cleft palate revision
- Choose 42210 when bone grafting to the alveolar ridge is part of the repair. 42205 represents ridge closure without that graft component.
- 42200Cleft palate repair
- 42200 is for a soft-tissue cleft palate repair. 42210 includes reconstruction of the alveolar ridge with bone grafting.
- 42215Cleft palate repair
- 42215 is used for a major revision of cleft palate reconstruction; 42210 is selected for the alveolar ridge closure and bone grafting service described by the operative work.
42210 billing questions
How is 42210 distinguished from 42205?
Use 42210 when the cleft palate reconstruction includes bone grafting to the alveolar ridge. 42205 describes ridge closure without that bone graft component.
Can the bone graft be billed separately?
The grafting to the alveolar ridge is included in 42210. Report a separate service only when a distinct, separately reportable procedure is supported and applicable coding rules allow it.
Should modifier 50 be used for a bilateral cleft?
No. CMS identifies bilateral adjustment as inappropriate for this code, so modifier 50 is not the way to report the repair.
What documentation supports 42210?
The operative report should establish the cleft-related alveolar ridge defect, closure of the ridge, and bone grafting performed as part of the reconstruction.
How does the 90-day global period affect postoperative visits?
The day-before preoperative visit and 90 days of related postoperative care are included in the global period.
Can an assistant surgeon be reported?
CMS permits assistant-at-surgery payment for this service. Co-surgeon and team-surgery billing are not permitted under the listed CMS rules.
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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