$225.67–$255.26
42104 describes lesion excision without closure. 42107 includes complex repair of the excision site.
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CMS RVU26D · Effective 2026-10-01
42107 Palatal lesion excision Medicare reimbursement rates in Washington
Reports removal of a lesion of the palate or uvula when the excision is followed by complex repair of the resulting site. Compare 42107 office and facility rates across CMS payment localities in Washington.
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 42107 in Washington?
Washington has 2 payment localities in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the 2 payment areas shown below, using the same CMS release.
Office / nonfacility
$483.86–$543.06
2 of 2 localities have a supported rate.
Facility setting
$309.06–$339.38
2 of 2 localities have a supported rate.
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.
Oral surgery
About 42107: Palatal lesion excision with complex repair
Reports removal of a lesion of the palate or uvula when the excision is followed by complex repair of the resulting site.
An otolaryngologist, oral and maxillofacial surgeon, or other qualified surgeon may use this code to remove a lesion from the palate or uvula and perform complex repair of the excision site. The service may occur in an office or facility setting; the operative record should identify the lesion site, the excision, and the repair performed.
Choose this code when the documented repair is complex, rather than the simpler repair levels represented by sibling codes. The removal and complex repair are reported together, not as separate excision and closure services. Medicare assigns a 90-day global period, which includes 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% reduction. Modifier 50 is inappropriate. Medicare does not pay an assistant at surgery, and co-surgeons and team surgery are not permitted.
CMS billing rules for 42107
- 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
- Statutory restriction: assistant at surgery is not paid.
- Co-surgeons
- Co-surgeons not permitted.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU4.45 · 32%
- Practice expense (office) RVU9.05 · 64%
- Malpractice RVU0.59 · 4%
132
Medicare services in 2024 · #4652 by national volume
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.
42107 compared with similar codes
Office rates for Washington, from the same CMS release.
$269.95–$304.78
42106 is the simple-repair level after palate or uvula lesion excision; 42107 is the complex-repair level.
$154.39–$173.69
42100 reports a biopsy, while 42107 reports lesion excision with complex repair.
No office rate
42120 is for palate resection or extensive lesion resection; 42107 covers lesion excision with complex repair.
Compare 42107 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.
2 of 2 payment localities
Rest Of Washington →
Office / nonfacility
$483.86
Facility
$309.06
Seattle (King Cnty) →
Office / nonfacility
$543.06
Facility
$339.38
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42107 billing questions
How does this differ from 42106?
42107 is for lesion excision with complex repair; 42106 represents the simple-repair level. The operative note should support the repair level reported.
Can the excision and repair be billed separately?
No. Complex repair is included in 42107; do not report a separate closure service for that repair.
When should 42100 be used instead?
42100 is for biopsy of a palate or uvula lesion. Use 42107 when the service is excision with complex repair rather than a biopsy.
Should modifier 50 be appended for lesions on both sides?
No. CMS identifies bilateral adjustment as inappropriate for this code, so modifier 50 should not be used.
What postoperative care is included?
The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.
Can an assistant or co-surgeon be reported?
Medicare does not pay an assistant at surgery for this service. 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 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.
4,99342100,,Biopsy roof of mouth,A,,1.33,2.98,,1.53,,0.18,4.49,3.04,0,010,0.10,0.80,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,99442104,,Excision lesion mouth roof,A,,1.65,4.67,,1.80,,0.22,6.54,3.67,0,010,0.10,0.80,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,99542106,,Excision lesion mouth roof,A,,2.10,5.46,,2.12,,0.27,7.83,4.49,0,010,0.10,0.80,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,99642107,,Excision lesion mouth roof,A,,4.45,9.05,,4.08,,0.59,14.09,9.12,0,090,0.09,0.81,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,9974210F,,Ace/arb thxpy for mos/>,I,,0.00,0.00,,0.00,,0.00,0.00,0.00,9,XXX,0.00,0.00,0.00,9,9,9,9,9,9,,33.4009,09,0,99,0.00,0.00,0.00
4,99842120,,Remove palate/lesion,A,,11.56,14.06,NA,14.06,,1.69,27.31,27.31,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,99942140,,Excision of uvula,A,,1.66,7.24,,2.66,,0.23,9.13,4.55,0,090,0.09,0.81,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00