$140.59–$155.15
42100 reports biopsy for diagnostic sampling. Choose 42106 when the lesion is excised and the wound receives a simple primary closure.
On this page
CMS RVU26D · Effective 2026-10-01
42106 Palate excision Medicare reimbursement rates in Texas
Removal of a lesion on the palate or uvula followed by simple primary closure, selected when the operative technique does not require a local flap. Compare 42106 office and facility rates across CMS payment localities in Texas.
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 42106 in Texas?
Texas has 8 payment localities in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the 8 payment areas shown below, using the same CMS release.
Office / nonfacility
$244.48–$271.22
8 of 8 localities have a supported rate.
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.
Where 42106 pays more and less in Texas
8 payment localities
$244.48 to $271.22
Oral surgery
About 42106: Palate lesion excision with simple closure
Removal of a lesion on the palate or uvula followed by simple primary closure, selected when the operative technique does not require a local flap.
This service removes a lesion from the palate or uvula and closes the resulting wound with a simple primary closure. It is typically performed by an otolaryngologist or oral and maxillofacial surgeon in an office or facility setting. The lesion may be submitted for pathologic examination; the code choice follows the operative method of removal and closure, not the eventual pathology result.
Report this code when the surgeon excises the lesion and closes the site directly without a local flap. The operative note should identify the palate or uvula site, describe the excision and closure, and distinguish simple closure from closure using a flap. CMS assigns a 10-day global period, including related postoperative visits during that interval. When other procedures are performed in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard multiple-procedure reduction. Modifier 50 is inappropriate for this code. Medicare does not pay an assistant at surgery for this service; co-surgeons and team surgery are not permitted.
CMS billing rules for 42106
- 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
- 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 RVU2.10 · 27%
- Practice expense (office) RVU5.46 · 70%
- Malpractice RVU0.27 · 3%
465
Medicare services in 2024 · #3626 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.
42106 compared with similar codes
Office rates for Texas, from the same CMS release.
$203.88–$226.76
42104 applies when the excision site is left without closure; 42106 applies when it is directly closed.
$442.01–$486.20
42107 includes closure with a local flap. A simple direct closure after excision supports 42106.
No office rate
42120 concerns palate resection or a more extensive palate lesion procedure. 42106 is for lesion excision with simple primary closure.
Compare 42106 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.
8 of 8 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Austin | Office $271.22 | Facility $153.19 |
| Beaumont | Office $244.48 | Facility $142.96 |
| Brazoria | Office $258.46 | Facility $147.91 |
| Dallas | Office $260.15 | Facility $149.04 |
| Fort Worth | Office $258.44 | Facility $148.45 |
| Galveston | Office $259.26 | Facility $148.48 |
| Houston | Office $264.20 | Facility $153.43 |
| Rest Of Texas | Office $251.35 | Facility $145.48 |
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42106 billing questions
How does this code differ from 42104?
42106 is used when the excision site receives a simple primary closure. 42104 describes excision without closure.
When is 42107 more appropriate?
Use 42107 when the surgeon closes the defect with a local flap. A direct simple closure supports 42106 instead.
Can a biopsy code be reported for the same lesion?
42100 describes biopsy of a palate or uvula site, rather than excision with simple closure. The operative documentation should support the service actually performed.
Is modifier 50 appropriate for lesions on both sides?
No. CMS identifies bilateral adjustment as inappropriate for this code; modifier 50 should not be used to report it as a bilateral procedure.
What postoperative care is included?
Related postoperative visits for 10 days are included in the global period.
How are other procedures in the same session paid?
The highest-valued procedure is paid in full, and other procedures 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.
4,9924201F,,Extrnl beam other than prost,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
4,99342100,,Biopsy roof of mouth,A,,1.33,2.98,,1.53,,0.18,4.49,3.04,0,010,0.10,0.80,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,99442104,,Excision lesion mouth roof,A,,1.65,4.67,,1.80,,0.22,6.54,3.67,0,010,0.10,0.80,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,99542106,,Excision lesion mouth roof,A,,2.10,5.46,,2.12,,0.27,7.83,4.49,0,010,0.10,0.80,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,99642107,,Excision lesion mouth roof,A,,4.45,9.05,,4.08,,0.59,14.09,9.12,0,090,0.09,0.81,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
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