$313.15
Use 42140 for excision limited to the uvula. Use 42145 when the surgeon reshapes the soft palate and pharyngeal tissues as well.
On this page
CMS RVU26D · Effective 2026-10-01
42145 Palatopharyngoplasty Medicare reimbursement rates in Rhode Island
Reports surgical reshaping of the soft palate and pharynx, often including the uvula, to address upper-airway obstruction such as obstructive sleep apnea. Compare 42145 office and facility rates across CMS payment localities in Rhode Island.
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 42145 in Rhode Island?
Rhode Island 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
$617.64
1 of 1 localities have a supported rate.
Payment area: Rhode Island
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.
Otolaryngology surgery
About 42145: Palatopharyngoplasty for airway obstruction
Reports surgical reshaping of the soft palate and pharynx, often including the uvula, to address upper-airway obstruction such as obstructive sleep apnea.
An otolaryngologist performs palatopharyngoplasty to reshape soft-palate and pharyngeal tissues, often including the uvula, to enlarge or stabilize the upper airway. Uvulopalatopharyngoplasty is a familiar example. The service is typically performed in an operating room for a patient with obstructive sleep apnea or another documented airway problem; it is more extensive than removing the uvula alone.
Report the code when the operative work includes reconstruction of the palate-pharynx region, not simply removal of a lesion or repair of an acute laceration. The operative report should describe the tissues addressed and the reconstructive work performed. Medicare assigns a 90-day global period, including the day-before preoperative visit and related postoperative care during that period. For multiple procedures 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 inappropriate. Medicare does not pay an assistant at surgery, and co-surgeon and team-surgery billing are not permitted.
CMS billing rules for 42145
- 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
- Statutory restriction: assistant at surgery is not paid.
- Co-surgeons
- Co-surgeons not permitted.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU9.54 · 52%
- Practice expense (office) RVU7.29 · 40%
- Malpractice RVU1.39 · 8%
361
Medicare services in 2024 · #3825 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.
42145 compared with similar codes
Office rates for Rhode Island, from the same CMS release.
No office rate
Code 42120 addresses resection of the palate or a palate lesion. Code 42145 describes palatopharyngeal reshaping for an airway problem, not lesion removal.
$260.40
Code 42180 is for repair of a small traumatic palate laceration. Code 42145 is reconstructive airway surgery, not acute wound repair.
No office rate
Code 42950 describes pharyngeal plastic surgery. Distinguish it from 42145 by the documented operative site and reconstruction; 42145 specifically addresses the palate-pharynx region, often for airway obstruction.
Compare 42145 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
Rhode Island →
Office / nonfacility
Unavailable
Facility
$617.64
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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 42145 in Rhode Island.
PPRRVU2026_Oct_nonQPP.csv
5,000
- Code
- 42145
- Physician work
- 9.54
- Practice expense
- 7.29
- Malpractice
- 1.39
GPCI2026.csv
92
- Locality
- Rhode Island
- Physician work
- 1.019
- Practice expense
- 1.033
- Malpractice
- 0.892
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 9.54 | × 1.019 | 9.7213 |
| Practice expense | 7.29 | × 1.033 | 7.5306 |
| Malpractice | 1.39 | × 0.892 | 1.2399 |
| Total RVUs | 18.4917 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Rhode Island$617.64
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 9.54 | 1.019 |
| Practice expense | 7.29 | 1.033 |
| Malpractice | 1.39 | 0.892 |
(9.54 × 1.019 + 7.29 × 1.033 + 1.39 × 0.892) × $33.4009 = $617.64
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.
42145 billing questions
How is this different from excision of the uvula?
Code 42145 describes palatal and pharyngeal reshaping, often including the uvula. Code 42140 is for excising the uvula without the broader palatopharyngeal reconstruction.
Can a tonsillectomy be reported with this procedure?
A tonsillectomy may be performed during the same operation. Document the tonsillar work separately and assess its reporting under applicable coding edits.
Should modifier 50 be used for work on both sides?
No. The CMS bilateral adjustment does not apply to this code, and modifier 50 is inappropriate.
Can an assistant surgeon or co-surgeon be reported?
Medicare does not pay an assistant at surgery for this code. Co-surgeons and team surgery are not permitted.
What postoperative care is included?
The 90-day global period includes the day-before preoperative visit and related postoperative care during the 90 days after surgery.
How is payment adjusted when multiple procedures are performed in one session?
The highest-valued procedure is paid in full; other procedures in the same session are subject to the standard multiple-procedure reduction.
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.
4,9974210F,,Ace/arb thxpy for 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
4,99842120,,Remove palate/lesion,A,,11.56,14.06,NA,14.06,,1.69,27.31,27.31,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,99942140,,Excision of uvula,A,,1.66,7.24,,2.66,,0.23,9.13,4.55,0,090,0.09,0.81,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,00042145,,Repair palate pharynx/uvula,A,,9.54,7.29,NA,7.29,,1.39,18.22,18.22,0,090,0.09,0.81,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,00142160,,Treatment mouth roof lesion,A,,1.80,4.94,,1.84,,0.22,6.96,3.86,0,010,0.10,0.80,0.10,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,00242180,,Repair lac palate<2 cm,A,,2.49,4.78,,2.20,,0.36,7.63,5.05,0,010,0.10,0.80,0.10,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,00342182,,Repair palate,A,,3.77,5.54,,2.51,,0.54,9.85,6.82,0,010,0.10,0.80,0.10,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
8912502,PA,01,METROPOLITAN PHILADELPHIA,1.018,1.041,1.193
9012502,PA,99,REST OF PENNSYLVANIA,1.000,0.918,0.945
9109202,PR,20,PUERTO RICO,1.000,1.011,0.985
9214412,RI,01,RHODE ISLAND,1.019,1.033,0.892
9311202,SC,01,SOUTH CAROLINA,1.000,0.924,0.850
9403402,SD,02,SOUTH DAKOTA**,1.000,1.000,0.336
9510312,TN,35,TENNESSEE,1.000,0.909,0.537