Billing code 42180: Palate repairMedicare rate & RVUs in Utah
Repair a palatal laceration measuring less than 2 cm, typically after oral trauma, when the clinician closes the wound rather than excising a lesion.
Medicare pays $244.04 for 42180 in the office in Utah (Utah). 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 42180 covers
This service covers closure of a short laceration of the palate, such as an acute traumatic wound involving palatal tissue. An otolaryngologist, oral and maxillofacial surgeon, or other qualified clinician may perform the repair in an operating room or another setting equipped for the procedure. The operative record should identify the injured palatal site, document a wound length under 2 cm, and describe the repair performed.
Report the code for the laceration repair itself, not for a biopsy or removal of a palatal lesion. The code has a 10-day global period, which includes related postoperative visits during that period. 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 multiple procedure reduction. Modifier 50 is inappropriate for this repair. 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.
42180 in Utah
| Payment locality | Office | Facility |
|---|---|---|
| Utah | $244.04 | $163.04 |
How the 42180 rate is calculated
Each of 42180’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 · 42180
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 2.49Practice expense 4.78Malpractice 0.36
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 42180
42180 has a 10-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 42180
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 · 42180
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
42180 without 51 · national office
$254.85
Palate repair
42180-51 · Second procedure: 50%
$127.43
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%).
42180 compared with similar codes
Compare codes
42180 vs 42182 vs 42100 vs 42104: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 42182Palate repair
- 42180 is limited to a palatal laceration under 2 cm. Select between these palate-repair codes from the complete descriptor and the documented operative service.
- 42100Palate biopsy
- 42100 is for biopsy of the roof of the mouth. It applies when tissue is sampled for diagnosis, not when a laceration is closed.
- 42104Palatal excision
- 42104 addresses excision of a lesion of the palate. It is not the code for suturing a traumatic palatal laceration.
42180 billing questions
How does this code differ from 42182?
Use 42180 for a palatal laceration under 2 cm. Check the complete descriptor and documented operative work before selecting 42182 for a different palate repair.
Can a palatal biopsy or lesion excision be reported as this repair?
No. This code describes closure of a laceration; biopsy and lesion excision are different services, even when performed on the palate.
Are related postoperative visits separately reported?
Related postoperative visits during the 10-day global period are included in the procedure's global service.
Should modifier 50 be used for a wound involving both sides of the palate?
No. Modifier 50 is inappropriate for this code; document the laceration and repair performed.
When is an assistant at surgery payable?
Only when the record documents medical necessity for the assistant. Co-surgeons and team surgery are not permitted for this code.
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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