CPT 42180: Simple Palatal Wound Repair, Up to 2 cm

Medicare pays $263 on average nationally for this procedure.

CPT code 42180 describes a simple repair of a wound in the palate up to 2 cm, a minor surgical procedure typically classified as an oral/maxillofacial soft tissue repair performed in an ambulatory surgery center, outpatient clinic, or dental/oral surgery office; the service involves layered closure of palatal mucosa to restore tissue integrity and function and is coded for documentation and billing of the specific repair size and site.

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CPT 42180: Simple Palatal Wound Repair, Up to 2 cm

Medicare pays $263 on average nationally for this procedure.

Customize your policy alerts

Sign up for cpt 42180 policy alerts

Get alerted when payer policies referencing 42180 are released or updated.

Monitor payer policy activity

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Clinical & Coding Specifications

Clinical Context

A typical patient is a child or adult who presents to an emergency department, urgent care clinic, or outpatient oral surgery clinic after sustaining a laceration to the hard or soft palate from trauma (e.g., fall, sports injury, bite) or an iatrogenic wound following dental extraction or appliance placement. The provider evaluates the oral cavity, controls bleeding, performs anesthetic infiltration (local nerve block or local infiltration), irrigates the wound, and performs a simple primary closure of the mucosal and submucosal layers of the palate for a wound measuring up to 2 cm. The workflow includes brief history and exam, documentation of wound size, location (palate), hemostasis achieved, suture type and technique, and post-procedure instructions for oral hygiene and diet. Typical sites of service are the emergency department, urgent care center, or ambulatory surgical/oral surgery clinic. Usual patient scenario includes local anesthesia only, a single wound ≤2 cm, no complex flap or layered reconstruction, and discharge with routine follow-up.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
Data not available in the input.	Data not available in the input.	Data not available in the input.

Related Modifiers

5 rows

Modifier	Description	When to Use
25	CPT modifier 25 indicates that on the same day as another procedure or service, the same physician or other qualified health care professional provided a significant, separately identifiable…	- When to apply: Use modifier 25 only on an E/M code to indicate the same provider delivered a significant, separately identifiable E/M service on the same day as another procedure or service — i.e.,…
26	Modifier 26 (Professional Component) identifies and bills only the professional portion of a split service — the physician’s interpretation, report, and medical judgment — when the technical…	- Use CPT Modifier -26 when you are billing only the professional component (PC) of a split‑bill eligible service—i.e., you performed the physician interpretation, medical judgment and prepared a…
57	CPT® modifier -57 (“Decision for Surgery”) is appended to an Evaluation and Management (E/M) service when that encounter results in the initial decision to perform a major surgery (a procedure with a…	- Use modifier 57 when an E/M service provided by the same provider (or same tax ID) on the day of or the day before a major surgical procedure (90‑day global period) results in the initial decision…
22	Modifier –22 (Increased Procedural Services) is used when a reported procedure is substantially more extensive than normally required. The CPT Manual and CMS state it may be appended only when the…	- When to use: Append modifier -22 to a procedural CPT code when the service performed is substantially more extensive than the usual service described by that code — i.e., the procedure required…
74	Modifier ‑74 indicates an outpatient hospital or ASC procedure that was discontinued after anesthesia was administered and after the procedure had begun. Use this modifier when anesthesia (local,…	- Use modifier -74 when a procedure in an outpatient hospital or ASC setting is terminated after anesthesia has been administered and after the procedure has commenced (for example, after incision,…

Related Provider Taxonomies

8 rows

Taxonomy Code	Specialty	Notes
341600000X	Ambulance	An emergency vehicle used for transporting patients to a health care facility after injury or illness. Types of ambulances used in the United States i…
251B00000X	Case Management Agency	An organization that is responsible for providing case management services. The agency provides services which assist an individual in gaining access…
103TM1700X	Deactivated - Psychologist Men & Masculinity
207UN0902X	Nuclear Imaging & Therapy Physician	A nuclear medicine physician who specializes in nuclear imaging and therapy.
225XE0001X	Environmental Modification Occupational Therapist	Occupational therapy practitioners are experts at identifying the cause of difficulties in performance of activities of daily living and instrumental …
247ZC0005X	Clinical Laboratory Director (Non-physician)	An individual who is state-licensed as a clinical laboratory director and meets the qualifications in the Clinical Laboratory Improvement Amendments o…
261QS1000X	Student Health Clinic/Center	Ambulatory Health Care Facilities · Clinic/Center
2086S0122X	Plastic and Reconstructive Surgery Physician	A surgeon who specializes in plastic and reconstructive surgery.

Related ICD-10-CM Codes

20 rows

ICD-10-CM Code	Description
F10.21	Alcohol dependence, in remission
J39.0	Retropharyngeal and parapharyngeal abscess
J39.1	Other abscess of pharynx
K02.9	Dental caries, unspecified
K03.6	Deposits [accretions] on teeth
K09.8	Other cysts of oral region, not elsewhere classified
K11.3	Abscess of salivary gland
K11.5	Sialolithiasis
K11.7	Disturbances of salivary secretion
K13.0	Diseases of lips

Showing 1–10 of 20

Related Codes

CPT-42182-PALATINE-WOUND-REPAIR-COMPLEX

CPT 42182: Palatal Wound Repair, Complex

CPT-42200-PALATOPLASTY-CLEFT-PALATE-REPAIR

CPT 42200: Palatoplasty for Cleft Palate Repair

CPT-42205-PALATOPLASTY-CLOSURE-CLEFT-PALATE-ALVEOLAR-RIDGE

CPT 42205: Palatoplasty for Cleft Palate Extending to Alveolar Ridge

CPT-42210-PALATOPLASTY-ALVEOLAR-RIDGE-CLOSURE-BONE-GRAFT

CPT 42210: Palatoplasty with Alveolar Ridge Closure and Bone Graft

CPT-42215-MAJOR-REVISION-CLEFT-PALATOPLASTY

CPT 42215: Major Revision of Prior Palatoplasty

CPT-42220-PALATOPLASTY-CLEFT-PALATE-SOFT-PALATE-LENGTHENING

CPT 42220: Palatoplasty for Cleft Palate with Soft Palate Lengthening

CPT-42225-PHARYNGEAL-FLAP-REVISION-CLEFT-PALATE

CPT 42225: Revision of Cleft Palate Incisions with Pharyngeal Flap

CPT-42226-SOFT-PALATE-LENGTHENING-TISSUE-TRANSFER

CPT 42226: Palatoplasty With Pharyngeal and Palatine Flaps

CPT-42227-PALATAL-LENGTHENING-ISLAND-FLAP-RECONSTRUCTION

CPT 42227: Soft Palate Lengthening with Island Flaps

CPT-42235-HARD-PALATE-REPAIR-VOMER-FLAP

CPT 42235: Repair of Hard Palate with Vomer Flap

Showing 1–10 of 13

Frequently Asked Questions

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.

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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.

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Clinical & Coding Specifications

Clinical Context

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
Data not available in the input.	Data not available in the input.	Data not available in the input.

Related Modifiers

5 rows

Modifier	Description	When to Use
25	CPT modifier 25 indicates that on the same day as another procedure or service, the same physician or other qualified health care professional provided a significant, separately identifiable…	- When to apply: Use modifier 25 only on an E/M code to indicate the same provider delivered a significant, separately identifiable E/M service on the same day as another procedure or service — i.e.,…
26	Modifier 26 (Professional Component) identifies and bills only the professional portion of a split service — the physician’s interpretation, report, and medical judgment — when the technical…	- Use CPT Modifier -26 when you are billing only the professional component (PC) of a split‑bill eligible service—i.e., you performed the physician interpretation, medical judgment and prepared a…
57	CPT® modifier -57 (“Decision for Surgery”) is appended to an Evaluation and Management (E/M) service when that encounter results in the initial decision to perform a major surgery (a procedure with a…	- Use modifier 57 when an E/M service provided by the same provider (or same tax ID) on the day of or the day before a major surgical procedure (90‑day global period) results in the initial decision…
22	Modifier –22 (Increased Procedural Services) is used when a reported procedure is substantially more extensive than normally required. The CPT Manual and CMS state it may be appended only when the…	- When to use: Append modifier -22 to a procedural CPT code when the service performed is substantially more extensive than the usual service described by that code — i.e., the procedure required…
74	Modifier ‑74 indicates an outpatient hospital or ASC procedure that was discontinued after anesthesia was administered and after the procedure had begun. Use this modifier when anesthesia (local,…	- Use modifier -74 when a procedure in an outpatient hospital or ASC setting is terminated after anesthesia has been administered and after the procedure has commenced (for example, after incision,…

Related Provider Taxonomies

8 rows

Taxonomy Code	Specialty	Notes
341600000X	Ambulance	An emergency vehicle used for transporting patients to a health care facility after injury or illness. Types of ambulances used in the United States i…
251B00000X	Case Management Agency	An organization that is responsible for providing case management services. The agency provides services which assist an individual in gaining access…
103TM1700X	Deactivated - Psychologist Men & Masculinity
207UN0902X	Nuclear Imaging & Therapy Physician	A nuclear medicine physician who specializes in nuclear imaging and therapy.
225XE0001X	Environmental Modification Occupational Therapist	Occupational therapy practitioners are experts at identifying the cause of difficulties in performance of activities of daily living and instrumental …
247ZC0005X	Clinical Laboratory Director (Non-physician)	An individual who is state-licensed as a clinical laboratory director and meets the qualifications in the Clinical Laboratory Improvement Amendments o…
261QS1000X	Student Health Clinic/Center	Ambulatory Health Care Facilities · Clinic/Center
2086S0122X	Plastic and Reconstructive Surgery Physician	A surgeon who specializes in plastic and reconstructive surgery.

Related ICD-10-CM Codes

20 rows

ICD-10-CM Code	Description
F10.21	Alcohol dependence, in remission
J39.0	Retropharyngeal and parapharyngeal abscess
J39.1	Other abscess of pharynx
K02.9	Dental caries, unspecified
K03.6	Deposits [accretions] on teeth
K09.8	Other cysts of oral region, not elsewhere classified
K11.3	Abscess of salivary gland
K11.5	Sialolithiasis
K11.7	Disturbances of salivary secretion
K13.0	Diseases of lips

Showing 1–10 of 20

Related Codes

CPT-42182-PALATINE-WOUND-REPAIR-COMPLEX

CPT 42182: Palatal Wound Repair, Complex

CPT-42200-PALATOPLASTY-CLEFT-PALATE-REPAIR

CPT 42200: Palatoplasty for Cleft Palate Repair

CPT-42205-PALATOPLASTY-CLOSURE-CLEFT-PALATE-ALVEOLAR-RIDGE

CPT 42205: Palatoplasty for Cleft Palate Extending to Alveolar Ridge

CPT-42210-PALATOPLASTY-ALVEOLAR-RIDGE-CLOSURE-BONE-GRAFT

CPT 42210: Palatoplasty with Alveolar Ridge Closure and Bone Graft

CPT-42215-MAJOR-REVISION-CLEFT-PALATOPLASTY

CPT 42215: Major Revision of Prior Palatoplasty

CPT-42220-PALATOPLASTY-CLEFT-PALATE-SOFT-PALATE-LENGTHENING

CPT 42220: Palatoplasty for Cleft Palate with Soft Palate Lengthening

CPT-42225-PHARYNGEAL-FLAP-REVISION-CLEFT-PALATE

CPT 42225: Revision of Cleft Palate Incisions with Pharyngeal Flap

CPT-42226-SOFT-PALATE-LENGTHENING-TISSUE-TRANSFER

CPT 42226: Palatoplasty With Pharyngeal and Palatine Flaps

CPT-42227-PALATAL-LENGTHENING-ISLAND-FLAP-RECONSTRUCTION

CPT 42227: Soft Palate Lengthening with Island Flaps

CPT-42235-HARD-PALATE-REPAIR-VOMER-FLAP

CPT 42235: Repair of Hard Palate with Vomer Flap

Showing 1–10 of 13

Frequently Asked Questions

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.

Published by

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

CPT 42180: Simple Palatal Wound Repair, Up to 2 cm

Sign up for cpt 42180 policy alerts

CPT 42180: Simple Palatal Wound Repair, Up to 2 cm

Sign up for cpt 42180 policy alerts

Clinical & Coding Specifications

Clinical Context

Related CPT Codes

Related Modifiers

Related Provider Taxonomies

Related ICD-10-CM Codes

Related Codes

What procedure does CPT 42180 describe and where is it typically performed?

What is the typical clinical scenario and workflow for a 42180 service?

Does the page provide reimbursement rates or state-specific coverage rules for CPT 42180?

Are modifier guidance, taxonomy codes, related CPT codes, or related ICD-10 diagnoses listed for this code?

What limitations or boundaries of the CPT 42180 description does the page specify?

References

Clinical & Coding Specifications

Clinical Context

Related CPT Codes

Related Modifiers

Related Provider Taxonomies

Related ICD-10-CM Codes

Related Codes

What procedure does CPT 42180 describe and where is it typically performed?

What is the typical clinical scenario and workflow for a 42180 service?

Does the page provide reimbursement rates or state-specific coverage rules for CPT 42180?

Are modifier guidance, taxonomy codes, related CPT codes, or related ICD-10 diagnoses listed for this code?

What limitations or boundaries of the CPT 42180 description does the page specify?

References