Billing code 42145: PalatopharyngoplastyMedicare rate & RVUs in Texas
Reports surgical reshaping of the soft palate and pharynx, often including the uvula, to address upper-airway obstruction such as obstructive sleep apnea.
CMS doesn’t publish an office rate for 42145 in Texas.
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 42145 covers
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.
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 42145 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 of 8 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Austin | Unavailable | $618.03 |
| Beaumont | Unavailable | $583.35 |
| Brazoria | Unavailable | $598.71 |
| Dallas | Unavailable | $603.87 |
| Fort Worth | Unavailable | $602.03 |
| Galveston | Unavailable | $601.42 |
| Houston | Unavailable | $626.87 |
| Rest Of Texas | Unavailable | $591.64 |
How the 42145 rate is calculated
Each of 42145’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 · 42145
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 9.54Practice expense 7.29Malpractice 1.39
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 42145
42145 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 42145
Palatopharyngoplasty
| 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 · 42145
Palatopharyngoplasty
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
42145 without 51 · national facility
$608.56
Palatopharyngoplasty
42145-51 · Second procedure: 50%
$304.28
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%).
42145 compared with similar codes
Compare codes
42145 vs 42140 vs 42120 vs 42180 vs 42950: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 42140Uvula excision
- Use 42140 for excision limited to the uvula. Use 42145 when the surgeon reshapes the soft palate and pharyngeal tissues as well.
- 42120Palate resection
- Code 42120 addresses resection of the palate or a palate lesion. Code 42145 describes palatopharyngeal reshaping for an airway problem, not lesion removal.
- 42180Palate repair
- Code 42180 is for repair of a small traumatic palate laceration. Code 42145 is reconstructive airway surgery, not acute wound repair.
- 42950Pharyngoplasty
- 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.
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 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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