2025 CPT code 42200
(Active) Effective Date: N/A Revision Date: N/A Deletion Date: N/A Surgery - Palate and Uvula Repair Surgery Feed
Palatoplasty for cleft palate, involving the soft and/or hard palate.
Modifiers may be applicable depending on the specific circumstances of the procedure, including multiple procedures (51), reduced services (52), or other relevant modifiers.
Medical necessity for palatoplasty is established by the presence of a cleft palate causing functional impairment in speech, swallowing, or breathing.Documentation must support the impact of the cleft and the need for surgical intervention.
The surgeon is responsible for all aspects of the procedure, including pre-operative assessment, surgical repair, post-operative care, and follow-up.
In simple words: This surgery fixes a cleft palate, which is a split in the roof of the mouth. The surgeon closes the opening between the mouth and nose to improve speech, swallowing, and breathing.
Palatoplasty is a surgical procedure performed to correct a cleft palate.This involves closing the abnormal opening between the oral and nasal cavities. The procedure may include repair of the soft palate, hard palate, or both, depending on the patient's specific needs.Techniques may vary, but generally involve incisions in the palatal mucosa, elevation of mucosal flaps, repair of the levator muscle (if necessary), and closure of the cleft with sutures.
Example 1: A 1-year-old infant with a complete cleft palate undergoes palatoplasty to close the opening between the oral and nasal cavities., A 6-month-old infant with a partial cleft palate requiring repair of only the soft palate undergoes a palatoplasty., An older child with a previously repaired cleft palate requires a revision palatoplasty due to a fistula formation.
** The complexity of the palatoplasty procedure can vary significantly depending on the extent of the cleft, the patient's age, and the surgeon's technique.Always ensure accurate documentation to support the selection of this code.
- Revenue Code: P1G (MAJOR PROCEDURE - OTHER)
- RVU: Refer to the most up-to-date Relative Value Units (RVUs) information from CMS or a reliable medical billing resource.
- Global Days : The global period will vary depending on payer and specific circumstances.Check with your payer's guidelines.
- Payment Status: Active
- Modifier TC rule: No information available.Check with your payer for any TC modifier guidelines.
- Fee Schedule : Historical fee schedule data is not included in the provided source.Refer to a reputable medical billing resource for historical data.
- Specialties:Plastic Surgery, Oral and Maxillofacial Surgery, Pediatric Surgery
- Place of Service:Inpatient Hospital, Ambulatory Surgical Center