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CPT 42100: Palate or Uvula Tissue Removal for Pathology

CPT code 42100 represents surgical removal of tissue from the palate or uvula for pathological analysis. The code captures a focused operative specimen collection procedure performed to obtain tissue for diagnostic evaluation of oropharyngeal abnormalities such as lesions, masses, or suspected neoplasia. Nationally, accurate coding of this procedure supports appropriate clinical documentation, pathology workflows, and claims adjudication when oral and oropharyngeal pathology is under evaluation.

Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the clinical context for the procedure, typical sites of service, common billing modifiers listed in the input, and the role of pathology submission in diagnostic pathways. The publication also summarizes benchmark considerations for reimbursement and claims processing, highlights relevant coding relationships, and notes where data was not available in the input. This content is intended to inform coding professionals, billing analysts, and clinical staff involved in procedural documentation and claims submission for oropharyngeal specimen collection.

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Billing Code Overview

CPT code 42100 describes a surgical procedure in which tissue is removed from the palate or uvula and submitted for pathological analysis. This service is generally classified as an operative specimen collection for pathology.

Service type: Surgical specimen removal for pathology analysis
Typical site of service: Ambulatory surgical center or hospital operating room, or other procedural setting where minor oral and oropharyngeal surgery is performed

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CPT 42100: Palate or Uvula Tissue Removal for Pathology

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Get alerted when payer policies referencing 42100 are released or updated.

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Billing Code Overview

Service type: Surgical specimen removal for pathology analysis
Typical site of service: Ambulatory surgical center or hospital operating room, or other procedural setting where minor oral and oropharyngeal surgery is performed

Clinical & Coding Specifications

Clinical Context

A typical patient is a 45-year-old adult referred to an otolaryngology clinic for evaluation of a suspicious palatal lesion or persistent uvular mass. The patient reports a focal area of ulceration or a firm nodular lesion on the soft palate or uvula that has failed conservative therapy or has concerning features (rapid growth, induration, bleeding). Examination in clinic using topical anesthesia demonstrates a discrete lesion amenable to outpatient excisional biopsy. The clinical workflow includes pre-procedure consent, topical or local infiltration anesthesia in the clinic or ambulatory surgery center, excisional or incisional removal of the palatal or uvular tissue, hemostasis, specimen labeling and submission to pathology, and brief post-procedure observation with discharge instructions. Typical sites of service are outpatient clinic procedure room or ambulatory surgery center; the procedure may occasionally be performed in an operating room for larger or complex lesions. Pathology processing and interpretation are separate services reported by the laboratory/pathologist when applicable.

Coding Specifications

Modifier	Description	When to Use
`26`	Professional component	When reporting only the physician's professional service separate from technical components (rare for this code).
`50`	Bilateral procedure	If identical palatal/uvular biopsies are performed bilaterally and payer requires bilateral modifier.
`52`	Reduced services	If the procedure is partially reduced or not completed as planned.
`53`	Discontinued procedure	If the procedure is started but terminated due to extenuating circumstances.
`58`	Staged or related procedure or service by the same physician during the postoperative period	When the biopsy is planned as a staged procedure following an initial diagnostic surgery.
`59`	Distinct procedural service	When a separate, distinct surgical service is performed in addition to the palatal/uvular biopsy on the same date.
`62`	Two surgeons	When two surgeons with distinct surgical roles perform the procedure.
`76`	Repeat procedure by same physician	When the same physician repeats the biopsy on the same day.
`78`	Unplanned return to the operating/procedure room by the same physician following initial procedure for a related procedure during the postoperative period	If the patient returns to the procedure room for a complication related to the biopsy.
`79`	Unrelated procedure or service by the same physician during the postoperative period	If an unrelated procedure is performed during the global period.

Taxonomy Code	Specialty	Notes
208D00000X	Otolaryngology	Common specialty performing palatal/uvular biopsies.
207K00000X	Oral and Maxillofacial Surgery	May perform biopsies of palatal lesions, especially intraoral masses.
2080P0206X	Plastic and Reconstructive Surgery	Occasionally involved for complex resections or reconstruction of palatal defects.
207L00000X	General Surgery	May perform in certain practice settings or when combined with other procedures.
363LF0000X	Pathology & Laboratory Medicine	Provides specimen processing and diagnostic interpretation (technical/professional reporting separate).

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`J35.3`	Hypertrophy of tonsils and adenoids	May coexist with oropharyngeal pathology prompting evaluation that includes palatal inspection and possible biopsy.
`K13.0`	Glossitis	Local inflammatory or mucosal conditions may involve or mimic palatal lesions requiring biopsy to exclude neoplasm.
`K13.79`	Other diseases of oral soft tissues, not elsewhere classified	Includes benign or suspicious palatal lesions that may require histologic diagnosis.
`C09.9`	Malignant neoplasm of tonsil, unspecified	Suspicious oropharyngeal lesions near the palate/uvula may require biopsy to rule out malignancy.
`C10.9`	Malignant neoplasm of oropharynx, unspecified	Biopsy of palatal or uvular tissue may be performed when oropharyngeal cancer is suspected.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`40490`	Incision and drainage of peritonsillar abscess; without drainage of tonsillar crypts	May be performed if lesion represents an abscess requiring drainage rather than biopsy.
`42120`	Simple tonsillectomy and adenoidectomy; tonsillectomy with or without adenoidectomy, younger than 12 years	May be part of a broader or concurrent oropharyngeal surgical plan in pediatric cases.
`40499`	Unlisted procedure, nose, septum, turbinates (used for atypical or complex palatal procedures when no specific code exists)	Used when a palatal procedure is unusual and no specific CPT code applies.
`88305`	Level IV surgical pathology, gross and microscopic examination	Common pathology CPT for tissue submitted after biopsy; billed by the laboratory/pathologist.
`99213`	Office or other outpatient visit for the evaluation and management of an established patient, low to moderate complexity	Typical pre- or post-procedure outpatient E/M visit associated with the biopsy.

CPT 42104: Excision of Lesion from Palate or Uvula, No Closure

CPT-42106-PALATE-UVULA-LESION-EXCISION-SIMPLE-REPAIR

CPT 42106: Excision of Lesion from Palate or Uvula with Simple Repair

CPT-42107-PALATE-UVULA-LESION-EXCISION-LOCAL-FLAP

CPT 42107: Excision of Palate or Uvula Lesion with Local Flap Closure

CPT-42120-PALATAL-LESION-RESECTION-WIDE-AREA

CPT 42120: Resection of Palatal Lesion, Wide Area

CPT-42140-UVULOPALATOPHARYNGOPLASTY-UVULA-REMOVAL

CPT 42140: Uvula Removal (Uvulopalatopharyngoplasty)

CPT-42145-PALATOPHARYNGOPLASTY-UVULOPALATOPHARYNGOPLASTY

CPT 42145: Palatopharyngoplasty (uvulopalatopharyngoplasty)

CPT-42160-PALATE-UVULA-LESION-DESTRUCTION

CPT 42160: Destruction of Lesion on Palate or Uvula

Frequently Asked Questions

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Jul 29, 2026.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Jul 29, 2026.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Jul 29, 2026.

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Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Modifier	Description	When to Use
`26`	Professional component	When reporting only the physician's professional service separate from technical components (rare for this code).
`50`	Bilateral procedure	If identical palatal/uvular biopsies are performed bilaterally and payer requires bilateral modifier.
`52`	Reduced services	If the procedure is partially reduced or not completed as planned.
`53`	Discontinued procedure	If the procedure is started but terminated due to extenuating circumstances.
`58`	Staged or related procedure or service by the same physician during the postoperative period	When the biopsy is planned as a staged procedure following an initial diagnostic surgery.
`59`	Distinct procedural service	When a separate, distinct surgical service is performed in addition to the palatal/uvular biopsy on the same date.
`62`	Two surgeons	When two surgeons with distinct surgical roles perform the procedure.
`76`	Repeat procedure by same physician	When the same physician repeats the biopsy on the same day.
`78`	Unplanned return to the operating/procedure room by the same physician following initial procedure for a related procedure during the postoperative period	If the patient returns to the procedure room for a complication related to the biopsy.
`79`	Unrelated procedure or service by the same physician during the postoperative period	If an unrelated procedure is performed during the global period.

Taxonomy Code	Specialty	Notes
208D00000X	Otolaryngology	Common specialty performing palatal/uvular biopsies.
207K00000X	Oral and Maxillofacial Surgery	May perform biopsies of palatal lesions, especially intraoral masses.
2080P0206X	Plastic and Reconstructive Surgery	Occasionally involved for complex resections or reconstruction of palatal defects.
207L00000X	General Surgery	May perform in certain practice settings or when combined with other procedures.
363LF0000X	Pathology & Laboratory Medicine	Provides specimen processing and diagnostic interpretation (technical/professional reporting separate).

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`J35.3`	Hypertrophy of tonsils and adenoids	May coexist with oropharyngeal pathology prompting evaluation that includes palatal inspection and possible biopsy.
`K13.0`	Glossitis	Local inflammatory or mucosal conditions may involve or mimic palatal lesions requiring biopsy to exclude neoplasm.
`K13.79`	Other diseases of oral soft tissues, not elsewhere classified	Includes benign or suspicious palatal lesions that may require histologic diagnosis.
`C09.9`	Malignant neoplasm of tonsil, unspecified	Suspicious oropharyngeal lesions near the palate/uvula may require biopsy to rule out malignancy.
`C10.9`	Malignant neoplasm of oropharynx, unspecified	Biopsy of palatal or uvular tissue may be performed when oropharyngeal cancer is suspected.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`40490`	Incision and drainage of peritonsillar abscess; without drainage of tonsillar crypts	May be performed if lesion represents an abscess requiring drainage rather than biopsy.
`42120`	Simple tonsillectomy and adenoidectomy; tonsillectomy with or without adenoidectomy, younger than 12 years	May be part of a broader or concurrent oropharyngeal surgical plan in pediatric cases.
`40499`	Unlisted procedure, nose, septum, turbinates (used for atypical or complex palatal procedures when no specific code exists)	Used when a palatal procedure is unusual and no specific CPT code applies.
`88305`	Level IV surgical pathology, gross and microscopic examination	Common pathology CPT for tissue submitted after biopsy; billed by the laboratory/pathologist.
`99213`	Office or other outpatient visit for the evaluation and management of an established patient, low to moderate complexity	Typical pre- or post-procedure outpatient E/M visit associated with the biopsy.

CPT 42104: Excision of Lesion from Palate or Uvula, No Closure

CPT-42106-PALATE-UVULA-LESION-EXCISION-SIMPLE-REPAIR

CPT 42106: Excision of Lesion from Palate or Uvula with Simple Repair

CPT-42107-PALATE-UVULA-LESION-EXCISION-LOCAL-FLAP

CPT 42107: Excision of Palate or Uvula Lesion with Local Flap Closure

CPT-42120-PALATAL-LESION-RESECTION-WIDE-AREA

CPT 42120: Resection of Palatal Lesion, Wide Area

CPT-42140-UVULOPALATOPHARYNGOPLASTY-UVULA-REMOVAL

CPT 42140: Uvula Removal (Uvulopalatopharyngoplasty)

CPT-42145-PALATOPHARYNGOPLASTY-UVULOPALATOPHARYNGOPLASTY

CPT 42145: Palatopharyngoplasty (uvulopalatopharyngoplasty)

CPT-42160-PALATE-UVULA-LESION-DESTRUCTION

CPT 42160: Destruction of Lesion on Palate or Uvula

Frequently Asked Questions

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Jul 29, 2026.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Jul 29, 2026.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Jul 29, 2026.

Published by

Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.

OpenPayer

CPT 42100: Palate or Uvula Tissue Removal for Pathology

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Billing Code Overview

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CPT 42100: Palate or Uvula Tissue Removal for Pathology

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Billing Code Overview

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

References

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

References

CPT 42100: Palate or Uvula Tissue Removal for Pathology

Sign up for cpt 42100 policy alerts

Billing Code Overview

CPT 42100: Palate or Uvula Tissue Removal for Pathology

Sign up for cpt 42100 policy alerts

Billing Code Overview

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

What does CPT 42100 represent and where is it typically performed?

Is pathology billed separately when CPT 42100 is performed?

Which CPT modifiers might be used with CPT 42100 and when?

What related CPT codes should I consider when submitting a claim with CPT 42100?

Which specialties commonly perform CPT 42100 and who handles the pathology service?

References

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

What does CPT 42100 represent and where is it typically performed?

Is pathology billed separately when CPT 42100 is performed?

Which CPT modifiers might be used with CPT 42100 and when?

What related CPT codes should I consider when submitting a claim with CPT 42100?

Which specialties commonly perform CPT 42100 and who handles the pathology service?

References