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See a sample rate comparisonCPT 42180 Fee Schedule
Last Verified: October 2026
Healthcare providers use this code to document and receive reimbursement for visits that address moderate-level medical decision-making, often including multiple diagnoses or prescription management.
Repair Laceration Palate To 2 Cm
| Key Fact | Detail |
|---|---|
| Service Type | Surgery Surgical Procedures on the Digestive System |
| Common Place of Service | 21 - Inpatient Hospital 22 - On Campus Outpatient Hospital |
| Common Modifiers | 51 - Multiple procedures RT - Right side of body |
| Complexity Level | Moderate |
| Medicare Fee Schedule | $254.85 national non-facility rate (2026) · View Medicare rates for 42180 |
| Medicaid Fee Schedule | $198.455 median of the 8 states in the free preview · View Medicaid rates for 42180 |
National average reimbursement for CPT 42180 by major payers:
$313.45
$325.56
$344.26
$307.83
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CPT 42180
5 of 25 sample ratesHigher to lower in this preview
Memorial Hermann Endoscopy & Surgery Center North Houston, LLC, North Houston Endoscopy & Surgery Center
$1,831.00Published rateAdvanced Surgery Center Of Metairie LLC
Advanced Surgery Center Of Metairie
$566.00Published rateAllina Health Surgery Center- Vadnais Heights LLC
Allina Health Surgery Center Vadnais Heights LLC
$301.00Published rateAmerican Access Care Of Richmond Asc LLC, Azura Surgery Center River City
American Access Care Of Richmond Asc LLC
$150.00Published ratePlastic Surgery Specialists, PC
Plastic Surgery Specialists, P.C.
$44.00Published rate
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See a sample payer proposalCPT 42180 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 42180 code is part of the Surgery services used for Surgical Procedures on the Digestive System. It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.
The CPT 42180 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.
| Code | Complexity | Description |
|---|---|---|
| 42104-CPT | Moderate | Surgery To Remove Mouth Tumor, Surgery To Remove A Tumor From The Roof Of The Mouth. The Procedure Involves The Uvula At The Back Of The Mouth. |
| 42180-CPT | Moderate | Repair Laceration Palate To 2 Cm |
| 42182-CPT | Moderate | Repair Laceration Of Palate, Repair Laceration Of Palate Over 2 Cm Or Complexrepair Laceration Of Palate Over 2 Cm Or Complex |
| 42200-CPT | High | Surgery For Cleft Palate, Surgery To Close An Opening In The Roof Of The Mouth (Cleft Palate). The Procedure Includes Reconstructing The Natural Shape Of The Mouth. A Graft May Be Used. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 42180. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 42180 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.
Factors that affect fee schedules
Medicare & Medicaid Rates
Government-set reimbursement amounts
Private Insurance Rates
Negotiated rates between providers and insurance companies
Geographic Location
Costs may be higher in urban areas.
Provider Type
Hospital providers may have different rates than private practice.
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