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    v1.0.30
    OpenPayerBilling CodesRepair Procedures on the Palate and UvulaCPT cpt-42180-palatal-wound-repair-simple-upto-2cm
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    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.

    For related coverage guidance, see recent payer policy updates: Office-based Laryngeal Procedures, Otoacoustic Emissions Testing (for Oxford Only), Hearing Aids and Devices Including Wearable, Bone-Anchored, and Semi-Implantable (for Indiana Only).

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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 CodeDescriptionRelationship 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

    ModifierDescriptionWhen to Use
    25CPT 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.,…
    26Modifier 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…
    57CPT® 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…
    22Modifier –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…
    74Modifier ‑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
    341600000X
    251B00000X
    103TM1700X
    207UN0902X
    225XE0001X
    247ZC0005X
    261QS1000X
    2086S0122X

    Related ICD-10-CM Codes

    20 rows

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

    Showing 1–10 of 20

    Related Payer Policy Updates

    Specialty: Otorhinolaryngology (ENT)1 / 2

    10 rows

    PolicyPayerEffective Date
    Office-based Laryngeal ProceduresPremera Bluecross2026-10-06
    Otoacoustic Emissions Testing (for Oxford Only)UnitedHealthcare2026-10-01
    Hearing Aids and Devices Including Wearable, Bone-Anchored, and Semi-Implantable (for Indiana Only)UnitedHealthcare2026-10-01
    Injectable Dermal Fillers and Bulking Agents (for Kentucky Only)UnitedHealthcare2026-10-01
    Injectable Dermal Fillers and Bulking Agents (for New Mexico Only)UnitedHealthcare2026-10-01
    Injectable Dermal Fillers and Bulking AgentsUnitedHealthcare2026-10-01
    Injectable Dermal Fillers and Bulking AgentsUnitedHealthcare2026-10-01
    Injectable Dermal Fillers and Bulking Agents (for Nebraska Only)UnitedHealthcare2026-10-01
    Injectable Dermal Fillers and Bulking Agents (for Kansas Only)UnitedHealthcare2026-10-01
    Sinus Surgeries and Interventions (for North Carolina Only)UnitedHealthcare2026-10-01

    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. 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. 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. 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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