Summary & Overview
CPT 42106: Excision of Lesion from Palate or Uvula with Simple Repair
CPT code 42106 denotes excision of a lesion from the palate or uvula with simple repair. This surgical code captures a targeted head and neck soft-tissue procedure commonly performed in ambulatory surgical centers, hospital outpatient departments, and some office-based surgical settings. Nationally, accurate coding of 42106 matters for appropriate procedural reporting, clinical documentation alignment, and payment consistency for otolaryngology and oral maxillofacial services.
Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise explanation of the clinical service represented by the code, the typical sites of service, and the role this procedure plays in head and neck care pathways. The publication also summarizes common billing considerations and benchmarks where available, highlights relevant policy or coding clarifications, and provides clinical context to inform documentation and charge capture. Data not available in the input is noted where applicable, and the content is presented for a national audience without state-specific detail.
Billing Code Overview
CPT code 42106 describes a procedure in which the provider excises a lesion from the palate or uvula and closes the incision site using simple repair. The service involves removal of a localized lesion of the oropharyngeal soft tissues with straightforward wound closure.
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Service type: Surgical excision with simple repair
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Typical site of service: Ambulatory surgical center or hospital outpatient department, and potentially office-based surgical settings depending on facility capabilities
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult who presents to an otolaryngology or oral surgery clinic with a symptomatic mucosal lesion on the soft palate or uvula (for example, a benign mucous cyst, small papilloma, or suspicious pigmented lesion). The patient reports localized discomfort, foreign-body sensation, intermittent bleeding, or progressive growth. Initial evaluation includes history, focused oral and oropharyngeal examination, and photographic documentation. If malignancy is a concern, the provider performs a targeted excisional biopsy in the office or ambulatory surgical center under local anesthesia or monitored anesthesia care. The lesion is removed with a single incision and the mucosal defect is closed using simple primary repair (one-layer closure with simple interrupted or running sutures). Specimens are submitted to pathology. Typical workflow steps: pre-procedure consent and time-out, local anesthesia infiltration, lesion excision, hemostasis, simple closure of the mucosa, specimen labeling and pathology requisition, post-procedure instructions, and short-term follow-up for wound check and pathology review. Typical site of service is an ambulatory surgical center, hospital outpatient department, or office-based procedural suite. Service type is minor surgical excision with simple repair of a lesion of the palate or uvula.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
25 | Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure |