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or ZIP

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Switch every figure between Medicare dollars and work RVUs.

Conversion factor

Modifiers

42281

Insertion palate prosthesis

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Code typePrimary

Payment statusActive (A)

Global period10-day

Whole-Procedure Pricing

Line

Qty

Global fee

Pro fee

Primary42281Insertion palate prosthesis

$241.49

$153.64

RVU Breakdown

Component

Office

Facility

Work

1.93

Practice expense

5.03

2.40

Malpractice

0.27

Total RVU

7.23

4.60

Payment Policy & Modifiers

Allowed adjustments

Multiple procedure MPPRApplies

When billed with other procedures the same day: highest-valued paid 100%, the rest 50%.

Assistant surgeon -80/81/8216% · documented

Assistant at surgery (mod 80/81/82) paid at 16% if medical necessity is documented.

Not applicable to this code

Bilateral -50Co-surgeon -62Team surgeon -66Prof / tech split

Global surgery package

Payment covers the procedure plus related care for 10 days after. Of the total payment, 10% is attributed to pre-operative care, 80% to the procedure itself, and 10% to post-operative visits.

In plain English

Office vs. facility

Where the service happens. In your own clinic (office), Medicare also pays you for the room, staff and supplies — so it's higher. In a hospital or ASC, the facility bills that part separately.

wRVU

Work Relative Value Units — the physician-effort share of a code. Most employment contracts pay a set dollar amount per wRVU, independent of Medicare's rate.

Add-on codes

Billed only alongside a primary code. Use the steppers to add units — extra levels, leads or sides — to the whole-procedure total.

Conversion factor

The dollars-per-RVU Medicare multiplies by. Set once, it flows through every figure on this page. The QP rate applies to clinicians who qualify as Advanced APM participants — a small annual boost.

GPCI

Geographic Practice Cost Index — adjusts the work, practice-expense and malpractice RVUs for your locality's cost of living before they're multiplied by the conversion factor.

How payment is computed

Each RVU is scaled by your locality's GPCI, summed, then multiplied by the conversion factor:

(work·wGPCI
+ PE·peGPCI
+ MP·mpGPCI) × CF

This code's Global fee

(1.93·1.000
+ 5.03·1.000
+ 0.27·1.000) × $33.40 = $241.49

Full methodology — how we apply CMS's rules →