CPT code 42145 designates palatopharyngoplasty, a surgical procedure (including uvulopalatopharyngoplasty and uvulopharyngoplasty) performed to widen the oropharyngeal airway, commonly used in treating obstructive sleep apnea. Nationally, this code is important because surgical airway interventions remain a key treatment pathway when noninvasive therapies are ineffective or not tolerated. Payers commonly involved in coverage and payment decisions for this procedure include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare.

This publication provides a concise briefing on clinical context, typical settings of care, and the payer landscape affecting use of CPT code 42145. Readers will find benchmarks for utilization and payment where available, summaries of common policy themes (medical necessity criteria and site-of-service considerations), and explanations of how the procedure is reported administratively. The report also outlines practical coding context for clinicians and billing staff, including typical modifiers and billing considerations. Data not available in the input is identified explicitly where relevant. The goal is to inform hospital administrators, surgical teams, and revenue-cycle professionals about the coding and coverage environment for palatopharyngoplasty at a national level.