No office rate
Both codes concern palate lengthening. Use 42227 when muscle repositioning is part of the documented operation; distinguish 42226 by its specific operative service.
On this page
CMS RVU26D · Effective 2026-10-01
42227 Palate lengthening Medicare reimbursement rates in Vermont
Reports operative palate lengthening with muscle repositioning, typically to address a short palate or velopharyngeal dysfunction after cleft palate repair. Compare 42227 office and facility rates across CMS payment localities in Vermont.
Amounts below use the non-QP conversion factor for participating physicians. These are base physician payments before claim-level adjustments, not patient costs or total hospital charges.
What does Medicare pay for 42227 in Vermont?
Vermont has 1 payment locality in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the payment area shown below, using the same CMS release.
Office / nonfacility
No supported rate
Facility setting
$747.74
1 of 1 localities have a supported rate.
Payment area: Vermont
One mapped payment locality.
These are locality ranges, not averages or address-specific quotes. A facility-setting amount covers the physician service; it does not include a hospital’s separate bill. Choose a locality below to inspect its calculation, compare other payment areas, or price a percentage of Medicare.
Cleft palate surgery
About 42227: Palatal lengthening with muscle repositioning
Reports operative palate lengthening with muscle repositioning, typically to address a short palate or velopharyngeal dysfunction after cleft palate repair.
This operation lengthens the palate while repositioning palatal muscle, generally to improve velopharyngeal function when the palate is too short or does not close adequately. It may be performed as secondary surgery for a patient with a history of cleft palate repair. Plastic and craniofacial surgeons, oral and maxillofacial surgeons, or otolaryngologists may perform the procedure in an operating room.
Report 42227 when the operative record supports palate lengthening with muscle repositioning, rather than a different palatal repair or lengthening procedure. Document the indication, prior palate history when relevant, and the specific surgical work performed. Medicare 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 other procedures are subject to the standard 50% multiple-procedure reduction. Bilateral adjustment is inappropriate for this palatal procedure. An assistant at surgery may be paid; co-surgeon and team-surgery billing are not permitted.
CMS billing rules for 42227
- Global period
- Major surgery with a 90-day global period: the day-before preoperative visit and 90 days of related postoperative care are included.
- Multiple procedures
- Standard multiple procedure reduction: the highest-valued procedure is paid in full and others at 50% when performed in the same session.
- Bilateral procedures
- Bilateral adjustment does not apply; the descriptor or anatomy makes modifier 50 inappropriate.
- Assistant at surgery
- Assistant at surgery may be paid.
- Co-surgeons
- Co-surgeons not permitted.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU9.65 · 42%
- Practice expense (office) RVU12.15 · 52%
- Malpractice RVU1.40 · 6%
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.
42227 compared with similar codes
Office rates for Vermont, from the same CMS release.
No office rate
42225 represents a different secondary palatoplasty service. Choose 42227 when the documented work is palate lengthening with muscle repositioning.
No office rate
42200 is used for cleft palate reconstruction, while 42227 identifies palate lengthening with muscle repositioning. Base selection on the procedure actually performed.
Compare 42227 by payment locality
Find the payment area for your service address, then open its rate page for calculation inputs, release history and the percentage-of-Medicare tool. A city may cross payment-area boundaries; the ZIP lookup above helps resolve the location.
1 of 1 payment localities
Vermont →
Office / nonfacility
Unavailable
Facility
$747.74
Need rates for a whole code list?
Fee-sheet and API access are in early access. Tell us which codes and locations your team needs.
How this local rate is calculated
Each RVU component is multiplied by its own geographic practice cost index (GPCI). The three adjusted components are added, then multiplied by the conversion factor. These are the inputs used for 42227 in Vermont.
PPRRVU2026_Oct_nonQPP.csv
5,013
- Code
- 42227
- Physician work
- 9.65
- Practice expense
- 12.15
- Malpractice
- 1.40
GPCI2026.csv
105
- Locality
- Vermont
- Physician work
- 1.000
- Practice expense
- 0.990
- Malpractice
- 0.506
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 9.65 | × 1.000 | 9.6500 |
| Practice expense | 12.15 | × 0.990 | 12.0285 |
| Malpractice | 1.40 | × 0.506 | 0.7084 |
| Total RVUs | 22.3869 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Vermont$747.74
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 9.65 | 1 |
| Practice expense | 12.15 | 0.99 |
| Malpractice | 1.4 | 0.506 |
(9.65 × 1 + 12.15 × 0.99 + 1.4 × 0.506) × $33.4009 = $747.74
The office and facility calculations use their respective practice-expense RVUs. The facility amount here is the physician fee, not a separate hospital or facility bill.
42227 billing questions
How does 42227 differ from 42226?
Both are palate-lengthening procedures, but 42227 is the choice when the operative work includes muscle repositioning. Code 42226 describes a different palate-lengthening service; use the code that matches the documented operation.
What documentation supports 42227?
The operative report should identify the reason for lengthening and describe both the lengthening and palatal muscle repositioning performed. A diagnosis or history of cleft palate alone does not establish the specific procedure.
Does the 90-day global period include related follow-up?
Yes. The global period includes the day-before preoperative visit and 90 days of related postoperative care.
Can modifier 50 be used for bilateral work?
No. Bilateral adjustment is inappropriate for this palate procedure.
Can an assistant or co-surgeon be reported?
An assistant at surgery may be paid for this procedure. Co-surgeon and team-surgery billing are not permitted.
What happens if another procedure is performed in the same session?
Under the standard multiple-procedure rule, the highest-valued procedure is paid in full and the other procedure or procedures are subject to a 50% 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 indices and the applicable conversion factor. Unavailable or separately priced services are labeled rather than assigned a made-up amount.
Source: RVU26D. Effective 2026-10-01 through the day before 2027-01-01.
5,01042220,,Reconstruct cleft palate,A,,6.98,7.87,NA,7.87,,1.30,16.15,16.15,0,090,0.09,0.81,0.10,2,0,2,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,01142225,,Reconstruct cleft palate,A,,9.53,17.73,NA,17.73,,1.76,29.02,29.02,0,090,0.09,0.81,0.10,2,0,2,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,01242226,,Lengthening of palate,A,,10.09,13.43,NA,13.43,,1.47,24.99,24.99,0,090,0.09,0.81,0.10,2,0,2,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,01342227,,Lengthening of palate,A,,9.65,12.15,NA,12.15,,1.40,23.20,23.20,0,090,0.09,0.81,0.10,2,0,2,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,01442235,,Repair palate,A,,7.81,11.70,NA,11.70,,1.14,20.65,20.65,0,090,0.09,0.81,0.10,2,0,2,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,01542260,,Repair nose to lip fistula,A,,9.96,14.12,,6.17,,1.45,25.53,17.58,0,090,0.09,0.81,0.10,2,0,2,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,01642280,,Preparation palate mold,A,,1.55,3.77,,1.17,,0.22,5.54,2.94,0,010,0.10,0.80,0.10,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
10204412,TX,18,HOUSTON,1.008,0.993,1.376
10304412,TX,99,REST OF TEXAS,1.000,0.949,0.903
10403502,UT,09,UTAH,1.000,0.940,0.898
10514512,VT,50,VERMONT,1.000,0.990,0.506
10611302,VA,00,VIRGINIA,1.000,0.983,0.706
10709202,VI,50,VIRGIN ISLANDS,1.000,1.011,0.985
10802402,WA,02,SEATTLE (KING CNTY),1.050,1.227,0.817