Billing code 42000: Oral lesion drainageMedicare rate & RVUs in Texas
Drainage of an abscess, cyst, or hematoma involving the palate or uvula, reported when the clinician opens and evacuates the collection.
Medicare pays $149.46–$165.90 for 42000 in the office in Texas, from Beaumont to Austin. Which amount applies depends on the service address.
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 42000 covers
This service involves opening and draining a collection in the roof of the mouth or uvula, such as a palatal abscess or cyst. It may be performed by an oral and maxillofacial surgeon, dentist, or other qualified clinician in an office or facility setting. The code describes drainage at these specific sites, rather than a collection arising from the teeth or floor of the mouth.
Report it when the clinician actually drains the palate or uvula lesion. The record should identify the site and lesion and document the drainage performed. This minor procedure has a 10-day global period, including related postoperative visits during that period. When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and others are subject to the standard 50% reduction. Modifier 50 is inappropriate for this service. Assistant-at-surgery payment requires documented medical necessity; co-surgeons and team surgery are 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 42000 pays more and less in Texas
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
8 payment localities
$149.46 to $165.90
8 of 8 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Austin | $165.90 | $101.58 |
| Beaumont | $149.46 | $94.14 |
| Brazoria | $157.99 | $97.75 |
| Dallas | $159.06 | $98.52 |
| Fort Worth | $158.02 | $98.08 |
| Galveston | $158.50 | $98.14 |
| Houston | $161.80 | $101.44 |
| Rest Of Texas | $153.68 | $95.99 |
How the 42000 rate is calculated
Each of 42000’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 · 42000
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 1.25Practice expense 3.36Malpractice 0.18
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 42000
42000 has a 10-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 42000
Oral lesion drainage
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 010 | Minor procedure: the day of the procedure plus 10 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) | 0 | Not paid without supporting documentation. |
| 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) | 0.10/0.80/0.10 | Share of the payment for pre-op, the procedure itself, and post-op care. |
Global surgery period · 42000
Oral lesion drainage
10-day global period ends
Oct 11, 2026
Covers Oct 1, 2026 through Oct 11, 2026 (11 days).
Visit on Oct 31, 2026
After the global period ends: visits and procedures are billed normally.
What modifiers do to the payment
Modifier 51 · payment effect
With and without the modifier
42000 without 51 · national office
$159.99
Oral lesion drainage
42000-51 · Second procedure: 50%
$80.00
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%).
42000 compared with similar codes
Compare codes
42000 vs 41800 vs 42100: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 41800Gum drainage
- Choose 41800 for a collection arising from dentoalveolar structures. Code 42000 is for drainage involving the palate or uvula.
- 42100Palate biopsy
- 42100 represents biopsy of the palate or uvula for tissue diagnosis. Use 42000 when the service performed is drainage of a collection at those sites.
42000 billing questions
How does this differ from drainage of a floor-of-mouth collection?
Use 42000 for a collection involving the palate or uvula. A collection in the floor of the mouth is coded to the site-specific drainage service, such as 42010.
Can this code be used for a tooth-related abscess?
No. A collection arising from dentoalveolar structures is distinct from drainage involving the palate or uvula; 41800 covers the dentoalveolar site.
Is a related postoperative visit separately reported during the global period?
Related postoperative visits for 10 days are included in the procedure's global period.
Should modifier 50 be appended for drainage on both sides?
No. Modifier 50 is inappropriate for this service.
When can an assistant-at-surgery claim be paid?
Assistant-at-surgery payment is allowed only when medical necessity is documented. Co-surgeons and team surgery are not permitted.
How are other procedures in the same session paid?
Under the standard multiple procedure reduction, the highest-valued procedure is paid in full and other procedures are paid at 50%.
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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