Billing code 42227: Palate lengtheningMedicare rate & RVUs in Washington
Reports operative palate lengthening with muscle repositioning, typically to address a short palate or velopharyngeal dysfunction after cleft palate repair.
CMS doesn’t publish an office rate for 42227 in Washington.
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 42227 covers
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.
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 42227 pays more and less in Washington
| Payment locality | Office | Facility |
|---|---|---|
| Rest Of Washington | Unavailable | $789.42 |
| Seattle (King Cnty) | Unavailable | $874.58 |
How the 42227 rate is calculated
Each of 42227’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 · 42227
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 9.65Practice expense 12.15Malpractice 1.40
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 42227
42227 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 42227
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 · 42227
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
42227 without 51 · national facility
$774.90
Palate lengthening
42227-51 · Second procedure: 50%
$387.45
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%).
42227 compared with similar codes
Compare codes
42227 vs 42226 vs 42225 vs 42200: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 42226Palate lengthening
- Both codes concern palate lengthening. Use 42227 when muscle repositioning is part of the documented operation; distinguish 42226 by its specific operative service.
- 42225Cleft palate repair
- 42225 represents a different secondary palatoplasty service. Choose 42227 when the documented work is palate lengthening with muscle repositioning.
- 42200Cleft palate repair
- 42200 is used for cleft palate reconstruction, while 42227 identifies palate lengthening with muscle repositioning. Base selection on the procedure actually performed.
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 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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