CPT code 42107: Palatal lesion excision2026 Medicare rate & RVUs in Texas
Reports removal of a lesion of the palate or uvula when the excision is followed by complex repair of the resulting site.
Medicare pays $442.01–$486.20 for 42107 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 42107 covers
An otolaryngologist, oral and maxillofacial surgeon, or other qualified surgeon may use this code to remove a lesion from the palate or uvula and perform complex repair of the excision site. The service may occur in an office or facility setting; the operative record should identify the lesion site, the excision, and the repair performed.
Choose this code when the documented repair is complex, rather than the simpler repair levels represented by sibling codes. The removal and complex repair are reported together, not as separate excision and closure services. Medicare assigns a 90-day global period, which includes the day-before preoperative visit and 90 days of related postoperative care. When multiple procedures are performed 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-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 42107 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
$442.01 to $486.20
8 of 8 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Austin | $486.20 | $310.57 |
| Beaumont | $442.01 | $290.95 |
| Brazoria | $464.75 | $300.24 |
| Dallas | $467.95 | $302.61 |
| Fort Worth | $465.18 | $301.50 |
| Galveston | $466.30 | $301.46 |
| Houston | $477.10 | $312.26 |
| Rest Of Texas | $453.29 | $295.75 |
How the 42107 rate is calculated
Each of 42107’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 · 42107
RVUs × geographic indexes × conversion factor
Work4.45
4.45 RVUs× 1.000 GPCI
Practice expense9.05
9.05 RVUs× 1.000 GPCI
Malpractice0.59
0.59 RVUs× 1.000 GPCI
Adjusted RVUs
14.0900
Conversion factor
$33.4009
Medicare rate
$470.62
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 42107
42107 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 42107
Palatal lesion excision
| 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) | 1 | Not paid (statutory restriction). |
| 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 · 42107
Palatal lesion excision
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
42107 without 51 · national office
$470.62
Palatal lesion excision
42107-51 · Second procedure: 50%
$235.31
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%).
42107 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 42104Palatal excision
- 42104 describes lesion excision without closure. 42107 includes complex repair of the excision site.
- 42106Palate excision
- 42106 is the simple-repair level after palate or uvula lesion excision; 42107 is the complex-repair level.
- 42100Palate biopsy
- 42100 reports a biopsy, while 42107 reports lesion excision with complex repair.
- 42120Palate resection
- 42120 is for palate resection or extensive lesion resection; 42107 covers lesion excision with complex repair.
42107 billing questions
How does this differ from 42106?
42107 is for lesion excision with complex repair; 42106 represents the simple-repair level. The operative note should support the repair level reported.
Can the excision and repair be billed separately?
No. Complex repair is included in 42107; do not report a separate closure service for that repair.
When should 42100 be used instead?
42100 is for biopsy of a palate or uvula lesion. Use 42107 when the service is excision with complex repair rather than a biopsy.
Should modifier 50 be appended for lesions on both sides?
No. CMS identifies bilateral adjustment as inappropriate for this code, so modifier 50 should not be used.
What postoperative care is included?
The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.
Can an assistant or co-surgeon be reported?
Medicare does not pay an assistant at surgery for this service. Co-surgeons and team surgery are 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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