Billing code 42182: Palate repairMedicare rate & RVUs in Texas
Repair a palatal laceration measuring 2 cm or greater, typically after oral or facial trauma requiring surgical closure.
Medicare pays $311.06–$337.93 for 42182 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 42182 covers
billing code 42182 describes surgical closure of a palate laceration that measures at least 2 cm. The injury may involve the hard or soft palate. Otolaryngologists, oral and maxillofacial surgeons, and other surgeons who manage oral trauma may perform the repair in a hospital or other surgical setting. This is for closing a traumatic wound, not for removing a palatal lesion or performing planned reconstruction.
Report the code when the documented wound length meets the 2 cm threshold; record the injury site, measured length, and repair performed. The code has a 10-day global period, so related postoperative visits during that period are included. 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% multiple-procedure reduction. Modifier 50 is inappropriate for this code. An assistant at surgery is paid only when medical necessity is documented; 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 42182 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
$311.06 to $337.93
8 of 8 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Austin | $337.93 | $230.85 |
| Beaumont | $311.06 | $218.97 |
| Brazoria | $324.37 | $224.08 |
| Dallas | $326.83 | $226.03 |
| Fort Worth | $325.21 | $225.43 |
| Galveston | $325.61 | $225.11 |
| Houston | $335.49 | $235.00 |
| Rest Of Texas | $317.81 | $221.77 |
How the 42182 rate is calculated
Each of 42182’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 · 42182
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 3.77Practice expense 5.54Malpractice 0.54
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 42182
42182 has a 10-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 42182
Palate repair
| 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 · 42182
Palate repair
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
42182 without 51 · national office
$329.00
Palate repair
42182-51 · Second procedure: 50%
$164.50
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%).
42182 compared with similar codes
Compare codes
42182 vs 42180 vs 42145 vs 42120 vs 40831: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 42180Palate repair
- Both codes repair palatal lacerations; 42180 is for wounds under 2 cm, while 42182 is for wounds measuring 2 cm or greater.
- 42145Palatopharyngoplasty
- 42145 describes a palatopharyngeal or uvular procedure, rather than closure of an acute palatal laceration.
- 42120Palate resection
- 42120 is used to remove a palatal lesion; 42182 closes a traumatic laceration.
- 40831Laceration repair
- 40831 applies to a laceration of the oral vestibule. Use 42182 when the repaired wound is on the palate and meets its length threshold.
42182 billing questions
How do I choose between 42182 and 42180?
Use 42182 for a palatal laceration measuring 2 cm or greater. Code 42180 is for a laceration under 2 cm.
Does the 10-day global period include follow-up visits?
Related postoperative visits during the 10-day global period are included in the procedure.
Can modifier 50 be reported?
No. The bilateral adjustment does not apply, and modifier 50 is inappropriate for this code.
When can an assistant-at-surgery claim be paid?
Payment for an assistant at surgery requires documentation of medical necessity. Co-surgeons and team surgery are not permitted.
How are other procedures in the same session paid?
The highest-valued procedure is paid in full; other procedures in the same session are subject to the standard 50% 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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