Billing code 42226: Palate lengtheningMedicare rate & RVUs in Utah
Reports surgical palatal lengthening using an island flap, commonly to address a short palate and persistent velopharyngeal dysfunction after cleft-palate repair.
CMS doesn’t publish an office rate for 42226 in Utah.
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 42226 covers
This operation lengthens the palate by mobilizing an island flap of tissue while preserving its blood supply, then positioning it to add palatal reach. It may be performed for a short or scarred palate associated with velopharyngeal dysfunction, including in a patient with a history of cleft-palate repair. Plastic surgeons, otolaryngologists, and oral and maxillofacial surgeons with cleft or craniofacial expertise typically perform the procedure in an operating room.
Report 42226 when the operative work uses the island-flap approach; distinguish it from lengthening with a local flap or another secondary palatoplasty technique. The operative report should identify the indication, flap technique, tissue mobilization, and reconstructive work performed. CMS assigns a 90-day global period, including 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 others at 50%. Modifier 50 is inappropriate for this palatal procedure. An assistant at surgery may be paid; 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.
42226 in Utah
| Payment locality | Office | Facility |
|---|---|---|
| Utah | Unavailable | $802.77 |
How the 42226 rate is calculated
Each of 42226’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 · 42226
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 10.09Practice expense 13.43Malpractice 1.47
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 42226
42226 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 42226
Palate lengthening
| 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) | 2 | Paid. |
| 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 · 42226
Palate lengthening
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
42226 without 51 · national facility
$834.69
Palate lengthening
42226-51 · Second procedure: 50%
$417.35
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%).
42226 compared with similar codes
Compare codes
42226 vs 42227 vs 42220 vs 42225: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 42227Palate lengthening
- Both codes describe palatal lengthening, but 42226 uses an island flap and 42227 uses a local flap. Use the flap technique documented in the operative report.
- 42220Cleft palate repair
- 42220 describes secondary palatoplasty to lengthen the palate. Choose 42226 when the documented lengthening is performed with an island flap.
- 42225Cleft palate repair
- 42225 describes secondary palatoplasty lengthening with additional cleft-palate repair work. 42226 identifies lengthening performed with an island flap.
42226 billing questions
How is 42226 distinguished from 42227?
42226 describes palatal lengthening using an island flap. 42227 is the related lengthening procedure using a local flap; the operative report should support the flap method reported.
What documentation supports 42226?
Document the reason for lengthening, the island-flap technique, how the tissue was mobilized and used to lengthen the palate, and relevant prior cleft-palate repair or scarring.
Can modifier 50 be reported?
No. Modifier 50 is inappropriate for this palatal procedure.
How does the 90-day global period affect postoperative reporting?
The global period includes the day-before preoperative visit and 90 days of related postoperative care. Those related services are included in the surgical global package.
How are other same-session procedures paid?
Under the standard multiple procedure reduction, the highest-valued procedure is paid in full and other procedures are paid at 50%. An assistant at surgery may be paid, but 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
Fee sheets
Put 42226 and the rest of your codes on one sheet
Build a fee sheet from your own code list at your locality, put your payer contracts beside Medicare, and see what changed each quarter.
Build my fee sheetOr price your code list free →