Summary & Overview
CPT 42107: Excision of Palate or Uvula Lesion with Local Flap Closure
CPT code 42107 captures surgical excision of a lesion on the palate or uvula with closure using a local flap. This oral and maxillofacial procedure addresses benign or malignant lesions and includes both resection and immediate local-tissue reconstruction. Nationally, accurate reporting of CPT code 42107 supports correct procedural classification, facilitates appropriate reimbursement for combined excision-plus-reconstruction services, and aids in tracking utilization of oral cavity surgical interventions.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context and typical settings for the procedure, and a summary of expected documentation elements tied to the combined excision and flap closure. The publication outlines common modifiers used with similar procedures (listed separately), typical sites of service such as outpatient surgical suites or hospital outpatient departments, and notes where input data was not provided.
This report is designed to help billing managers, clinical coders, and policy analysts understand the clinical intent of CPT code 42107, the procedural components it represents, and the operational contexts in which it is commonly performed. Data not available in the input is explicitly identified where applicable.
Billing Code Overview
CPT code 42107 describes surgical excision of a lesion located on the palate or uvula with closure of the surgical site using a local flap. This procedure involves removal of a growth or lesion from the soft tissues of the oral cavity and reconstruction of the defect by mobilizing adjacent tissue to cover the wound.
Service type: Surgical excision with local flap reconstruction
Typical site of service: Operating room or procedure suite in an outpatient surgical setting or hospital outpatient department
Clinical & Coding Specifications
Clinical Context
A 54-year-old patient presents with a symptomatic, enlarging mucosal lesion on the soft palate causing dysphagia and intermittent bleeding. After clinical evaluation and possible biopsy confirming a benign or early malignant pathology, the otolaryngology or oral and maxillofacial surgery team schedules an excisional procedure. In the operating room under monitored anesthesia care or general anesthesia, the surgeon excises the lesion from the palate or uvula and performs local tissue mobilization to create a flap and close the defect primarily. Typical perioperative workflow includes preoperative assessment, informed consent documenting lesion location and flap closure, intraoperative specimen handling for pathology, hemostasis, layered closure with a local flap, and postoperative instructions for oral care and activity restriction. Typical site of service is an ambulatory surgery center or hospital outpatient operating room. Service type is a surgical excision with local flap closure of a lesion of the palate or uvula, classified as an outpatient surgical procedure involving the oral cavity/ oropharynx.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when the procedure required substantially greater effort, time, or technical difficulty than typical (extensive dissection, complex flap design). |