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    v1.0.30
    OpenPayerBilling CodesRepair Procedures on the Palate and UvulaCPT cpt-42226-soft-palate-lengthening-tissue-transfer
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    CPT 42226: Palatoplasty With Pharyngeal and Palatine Flaps

    Medicare pays $858 on average nationally for this procedure.

    CPT code 42226 describes a surgical palatoplasty procedure to lengthen the soft palate by transferring tissue flaps, including pharyngeal flaps and flaps from the hard palate; this is an oropharyngeal reconstructive surgery typically performed as an operative procedure in an ambulatory surgical center or hospital operating room to address velopharyngeal insufficiency or related structural palate deficiencies.

    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 adult patient with velopharyngeal insufficiency (VPI) causing hypernasal speech, nasal regurgitation of liquids, or recurrent otitis media following cleft palate repair or congenital palatal dysfunction. The patient is referred by a speech-language pathologist or pediatric otolaryngologist for surgical evaluation after failed or inadequate improvement with speech therapy and prosthetic management (speech bulb or palatal lift). Preoperative evaluation includes nasoendoscopy or videofluoroscopy to assess velopharyngeal closure, audiology and middle ear assessment when otologic symptoms are present, and routine preoperative clearance. The surgical workflow typically involves general anesthesia, intraoperative assessment of palatal mobility, creation and transfer of tissue flaps (pharyngeal and/or hard palate flaps) to lengthen the soft palate and improve velopharyngeal closure, hemostasis, and layered closure. Postoperative care includes airway monitoring, pain control, feeding advancement, speech therapy follow-up, and outpatient otolaryngology or craniofacial clinic visits to assess speech outcomes and healing. Typical sites of service are an ambulatory surgical center or hospital operating room. Common patient modifiers include documented medical complexity or postoperative complications affecting coding and billing.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    42140Palatoplasty for cleft palate; repair of soft palateOften performed in primary cleft repair or concurrently in staged reconstruction; addresses palatal closure.
    42200Posterior pharyngeal flapRelated technique when a posterior pharyngeal flap is created to improve velopharyngeal closure; may be an alternative or component of palatal lengthening.
    21076Bone graft, mandible or maxilla; onlay graft, local, single siteMay be performed in complex craniofacial reconstructions where palatal lengthening requires bony support or donor site work.
    92507Treatment of speech, language, voice, communication, and/or auditory processing disorder; individualSpeech-language pathology services commonly provided pre- and postoperatively to assess and improve speech outcomes.
    31620Bronchoscopy, rigid or flexible; diagnostic, with or without collection of specimen(s)Not commonly linked; Data not available in the input.

    Related Modifiers

    11 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…
    76Modifier -76, Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional, is appended when the same provider performs an identical, medically necessary procedure or…- Use modifier -76 when the same physician or other qualified health care professional performs an identical procedure or service a second (or subsequent) time on the same date of service and the…
    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…

    Showing 1–10 of 11

    Related Provider Taxonomies

    8 rows

    Taxonomy Code
    208C00000X
    2080P0206X
    207L00000X
    2084P0800X
    103K00000X
    171000000X
    207RI0001X
    2081P0010X

    Related ICD-10-CM Codes

    22 rows

    ICD-10-CM CodeDescription
    F80.2Mixed receptive-expressive language disorder
    G47.30Sleep apnea, unspecified
    G47.33Obstructive sleep apnea (adult) (pediatric)
    J38.1Polyp of vocal cord and larynx
    K13.70Unspecified lesions of oral mucosa
    P94.2Congenital hypotonia
    Q35.1Cleft hard palate
    Q35.9Cleft palate, unspecified
    Q36.0Cleft lip, bilateral
    Q36.9Cleft lip, unilateral

    Showing 1–10 of 22

    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-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-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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