2025 CPT code 42205

Palatoplasty for cleft palate, closing the alveolar ridge's soft tissue.

Refer to the current CPT manual and other relevant coding guidelines for precise coding instructions.

Modifiers may be applicable depending on the circumstances of the procedure. Consult the CPT manual for guidance on appropriate modifier usage.

Surgical repair is medically necessary to improve feeding, speech, and the overall oral function in patients with cleft palates.The extent of the procedure (42205) depends on the specific anatomic defect.

The surgeon prepares the patient (possibly including endotracheal intubation), makes incisions in the palatal mucosa, raises mucosal flaps, repairs the levator muscle, controls bleeding, and closes the incisions with sutures.

IMPORTANT Review codes 42200 to 42225 for the most appropriate code. Also review 40700 to 40761 for plastic repair of cleft lip or nasal deformity.

In simple words: This surgery fixes a cleft palate (an opening in the roof of the mouth) by closing the gap in the soft tissue of the upper jawbone where teeth grow. The surgeon stitches the tissues together to seal the opening.

This procedure involves surgical repair of a cleft palate, specifically addressing the soft tissue of the alveolar ridge.The surgeon makes incisions in the palatal mucosa, raises mucosal flaps, repairs the levator muscle (reattaching it to the soft palate to close the fissure in the soft tissues of the alveolar ridge), controls bleeding, and closes the cleft and incisions with layered sutures.

Example 1: A six-month-old infant presents with a cleft palate extending to the soft tissue of the alveolar ridge.Palatoplasty (42205) is performed to close the opening., A one-year-old child undergoes a two-stage palatoplasty. The first stage addresses the soft tissue closure (42205), while the second stage may involve bone grafting (42210)., An older child requires a revision palatoplasty (42215) to correct residual or worsening deformities from a previous cleft palate repair.

* Preoperative evaluation including photographs and assessment of the cleft palate's extent.* Operative report detailing the surgical technique used, including the specific repair of the levator muscle and closure of the alveolar ridge's soft tissue.* Postoperative assessment of the repair, including photographs and notes on healing.* Documentation of any complications, such as fistulas or velopharyngeal dysfunction.

** Always verify code selection with the most current CPT guidelines and payer-specific requirements. This information is for guidance only and does not constitute medical advice.

  • Revenue Code: P1G (MAJOR PROCEDURE - OTHER)
  • RVU: Not available in provided data.Consult current RVU data for accurate values.
  • Global Days : Not specified in the provided data.Consult current guidelines for the global period.
  • Payment Status: Active
  • Modifier TC rule: The applicability of a Technical Component (TC) modifier depends on the specifics of the surgical setting and is determined by payer rules and guidelines. Consult payer-specific instructions.
  • Fee Schedule : Not available in provided data. Consult historical fee schedules for relevant information.
  • Specialties:Plastic Surgery, Oral and Maxillofacial Surgery, Pediatric Surgery
  • Place of Service:Inpatient Hospital, Ambulatory Surgical Center
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