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    OpenPayerBilling CodesRepair Procedures on the Palate and UvulaCPT cpt-42215-major-revision-cleft-palatoplasty
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    CPT 42215: Major Revision of Prior Palatoplasty

    Medicare pays $664 on average nationally for this procedure.

    CPT code 42215 describes a major revision of a previous cleft palate repair (palatoplasty), a reconstructive surgical procedure to correct persistent or recurrent palatal defects; the service is operative surgical care typically performed in an operating room or ambulatory surgery center under general anesthesia and includes the intraoperative work required for reopening and substantially revising the prior repair.

    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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    Table of contents

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    Clinical & Coding Specifications

    Clinical Context

    A pediatric or adolescent patient presents for a major revision of a prior cleft palate repair (palatoplasty) due to persistent velopharyngeal insufficiency, recurrent fistula, or tissue deficiency causing speech impairment and nasal regurgitation. The patient typically has a history of congenital cleft palate with prior primary palatoplasty performed in infancy and now demonstrates hypernasal speech, nasal escape on speech evaluation, or oronasal fistula identified on oral exam. Preoperative workflow includes multidisciplinary evaluation by a craniofacial team (plastic surgery or otolaryngology, speech-language pathology, and audiology), imaging as indicated, preoperative anesthesia assessment, and documentation of prior procedures and current functional deficits.

    On the day of service the patient undergoes general anesthesia in an ambulatory surgery center or hospital operating room. The surgeon performs extensive dissection, release of scar tissue, reconstruction or reorientation of palatal muscles (eg, levator veli palatini), possible tissue interposition or local flap advancement, and closure with layered repair. Intraoperative findings and the need for adjunctive procedures (eg, pharyngeal flap, buccal myomucosal flap, or fistula repair) are documented. Postoperative course includes airway monitoring, pain control, feeding precautions, and early speech therapy follow-up. Typical sites of service are hospital outpatient surgery departments and ambulatory surgical centers; inpatient admission may be required for airway concerns or complex revisions.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    41030Repair, cleft lip; primary, any agePerformed earlier in many patients as part of staged cleft care; not done concurrently with palatal revision routinely.
    42145Closure of nasal septal perforation; with flapMay be used if significant nasal septal involvement or perforation is addressed during revision.
    42200Division or excision of tongue-tie (frenotomy)May be performed concurrently if ankyloglossia contributes to feeding or speech issues, though uncommon.
    42270Repair, cleft palate; revision, minorUsed for less extensive revisions; selection depends on extent of revision needed compared with 42215.
    42820Repair of oronasal fistulaCommonly performed for fistula repair associated with prior palatoplasty and may be done at same operative setting.
    31500Intubation, endotracheal, emergency procedureRelates to anesthesia airway management; documented when specific airway procedures are required.

    Related Modifiers

    12 rows

    ModifierDescriptionWhen to Use
    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…
    23Modifier -23 (Unusual Anesthesia) is used on anesthesia service CPT codes when a procedure that normally requires no anesthesia or only local anesthesia must be performed under general anesthesia…- Use modifier -23 only on anesthesia CPT codes (00100–01999) when a procedure that normally requires no anesthesia or only local anesthesia must be performed under general anesthesia because of…
    52Modifier ‑52 (Reduced Services) indicates that a service or procedure was partially reduced or omitted at the provider’s discretion, allowing reporting of the basic procedure number with a qualifier…- Use modifier -52 when a physician or qualified health professional electively reduces or omits part of a procedure or service (for example, performing fewer required views or omitting a portion of…
    53Modifier 53 (Discontinued Procedure) signals that a surgical or diagnostic service was begun by the physician but terminated because of extenuating circumstances that threatened the patient’s…- Use modifier -53 when a physician/qualified healthcare professional has started a surgical or diagnostic procedure (e.g., anesthesia administered, incision or scope insertion) and then discontinues…
    62Modifier 62 indicates that two surgeons function as co‑surgeons, each performing distinct parts of the same primary surgical procedure. It is appended to the primary procedure code (and any…- Use modifier -62 when two surgeons act as co‑surgeons (both primary surgeons) on a single definitive primary procedure, each performing distinct parts of the same surgical procedure (append -62 to…
    66Modifier 66 (Surgical Team) is used when three or more surgeons act as primary surgeons on a single, highly complex procedure. The AMA defines it for use when a surgical team — often composed of…- Use modifier 66 when three or more surgeons act as primary surgeons working collaboratively as a surgical team on a single, highly complex or difficult procedure (for example organ…
    78CPT modifier -78 indicates an unplanned, related return to the operating or procedure room by the same provider during the global postoperative period. It is appended when treatment for a…- Use modifier -78 when an unplanned, related complication during the original procedure’s global postoperative period requires the patient to return to a formal operating or procedure room and the…
    79Modifier 79 indicates a surgical procedure performed during the postoperative global period of a prior surgery that is unrelated to the original procedure. Per AMA/CPT and CMS guidance, it is…- Use modifier 79 when the same physician (or same‑specialty physician in the same group) performs a surgical procedure during the postoperative global period of a prior surgery and the new procedure…
    80CPT® Modifier 80 (Assistant Surgeon) is appended to a surgical CPT code when a physician (MD or DO) provides full, continuous assistance throughout the operative procedure. It is intended only for…- Use CPT Modifier -80 when a physician (MD or DO) serves as an assistant surgeon and provides full, continuous assistance throughout the entire operative procedure; append -80 to the surgical CPT…
    81Modifier -81 indicates a physician served as a minimal assistant surgeon for part—not all—of an operative procedure. Use when a physician’s assisting role is limited and does not represent full…- Use CPT modifier -81 when a physician acts as a minimum assistant surgeon who assists during only part (a limited portion) of an operative procedure; append -81 to the primary surgical CPT code to…

    Showing 1–10 of 12

    Related Provider Taxonomies

    8 rows

    Taxonomy Code
    103T00000X
    207K00000X
    261QP2300X
    207RC0000X
    156FX1700X
    213ER0200X
    207X00000X
    103TH0004X

    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-42180-PALATAL-WOUND-REPAIR-SIMPLE-UPTO-2CM

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

    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-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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