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    OpenPayerBilling CodesRepair Procedures on the Palate and UvulaCPT cpt-42220-palatoplasty-cleft-palate-soft-palate-lengthening
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    CPT 42220: Palatoplasty for Cleft Palate with Soft Palate Lengthening

    Medicare pays $552 on average nationally for this procedure.

    CPT code 42220 describes a palatoplasty procedure for repair of a cleft palate that includes secondary lengthening of the soft palate; the service is a reconstructive surgical procedure performed by an otolaryngologist or plastic surgeon in an operating room or ambulatory surgical center under general anesthesia to restore palatal function and anatomy. Service type: reconstructive cleft palate repair. Typical site of service: hospital operating room or outpatient ambulatory surgery center.

    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 typical patient is a pediatric or adolescent patient presenting with a congenital or residual velopharyngeal insufficiency due to an unrepaired or recurrent cleft palate. The patient may have hypernasal speech, nasal air emission, feeding difficulties in infancy, or recurrent otitis media attributed to Eustachian tube dysfunction. Preoperative evaluation includes multidisciplinary assessment by plastic surgery or otolaryngology, speech-language pathology for resonance and articulation assessment, and often airway and anesthetic evaluation. The procedure, 42220 (palatoplasty with secondary lengthening of the soft palate), is performed in an operating room under general anesthesia. Intraoperative steps typically include elevation of mucoperiosteal and muscle flaps, reconstruction of the levator veli palatini sling, and posterior advancement/lengthening of the soft palate to improve velopharyngeal closure. Postoperative care includes airway monitoring, pain control, feeding instructions, speech therapy follow-up, and surveillance for wound dehiscence or oronasal fistula. Hospital or ambulatory surgery center settings are typical depending on patient age, comorbidities, and surgeon preference. Documentation should include preoperative assessment, operative note describing the palatoplasty technique and extent of soft palate lengthening, estimated blood loss, any concurrent procedures, and postoperative instructions.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    21026Repair of cleft lip and/or primary palatoplasty (secondary procedures have different codes)Performed in patients who present with combined lip and palate pathology; may precede or accompany palatal reconstruction in staged care.
    31536Repair of cleft palate or palatal fistula, surgical approach includes closure (limited)May be used for localized palatal fistula repair when smaller revision is required rather than full palatoplasty.
    42200Primary palatoplasty (repair of cleft palate without mention of secondary lengthening)Closely related; 42220 specifically denotes palatoplasty with secondary lengthening of the soft palate when additional posterior advancement is performed.
    42140Excision of lesion of palate; simpleOccasionally used for minor palatal lesion excision separate from reconstructive palatoplasty.
    92609Evaluation of speech and language (e.g., speech-language pathology assessment)Pre- and postoperative speech assessment to document velopharyngeal function and guide therapy; often performed in the care pathway.

    Related Modifiers

    13 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…
    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…
    50Modifier –50 (Bilateral Procedure) is appended to a CPT code when an identical procedure is performed on paired anatomical structures during the same operative session. The AMA states to add…- Use modifier -50 when the same CPT surgical, diagnostic, or radiology procedure is performed on paired anatomical structures (both sides of the body) during the same operative/session by the same…
    51Modifier –51 (Multiple Procedures) is used when the same provider performs multiple procedures in the same session to identify secondary, non‑exempt procedures and indicate payment reduction logic…- Use modifier -51 when the same provider performs multiple distinct procedures during the same patient encounter: report the highest‑valued procedure first (no modifier) and append -51 to…
    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…
    63Modifier‑63 is appended to surgical CPT codes (20000–69990) when a procedure is performed on a neonate or infant weighing ≤ 4 kg (about 8.8 lbs). The AMA/AAPC definition specifies this use and notes…- Use modifier -63 only for surgical procedures in the CPT 20000–69990 series performed on a neonate or infant who weighs ≤ 4 kg at the time of the procedure; it indicates increased complexity due 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…

    Showing 1–10 of 13

    Related Provider Taxonomies

    8 rows

    Taxonomy Code
    207K00000X
    207L00000X
    103T00000X
    225600000X
    208VP0000X
    246Z00000X
    246QM0706X
    207RS0010X

    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-42215-MAJOR-REVISION-CLEFT-PALATOPLASTY

    CPT 42215: Major Revision of Prior Palatoplasty

    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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