2025 CPT code 42226
(Active) Effective Date: N/A Revision Date: N/A Surgery - Repair Procedures on the Palate and Uvula Surgery Feed
Lengthening of the palate and pharyngeal flap; a surgical procedure to lengthen the soft palate and reduce nasal air escape during speech.
Modifiers may apply depending on the circumstances of the service.Refer to the most current CPT guidelines and modifier usage guidelines.
Medical necessity is established by demonstrating velopharyngeal insufficiency (VPI) causing hypernasality or other speech disorders, and failure of conservative management (e.g., speech therapy).
The surgeon performs the procedure after prepping and anesthetizing the patient.This includes making incisions, raising and suturing tissue flaps, and closing the incisions.
In simple words: This surgery makes the soft palate longer to improve speech.It involves moving tissue flaps to the soft palate and reducing air leakage from the nose during talking.
This procedure involves lengthening the soft palate by transferring tissue flaps, including pharyngeal flaps and flaps from the hard palate.A midline incision is made in the soft palate. Tissue may be raised from the posterior pharyngeal wall and sutured to the soft palate, leaving lateral holes open to prevent airflow obstruction. Flaps from the hard palate may also be advanced.The incision is closed in layers with sutures. This procedure aims to improve speech by reducing air escaping through the nose.
Example 1: A patient with velopharyngeal insufficiency (VPI) and hypernasality undergoes this procedure to improve speech clarity by reducing nasal air leakage., A patient with a cleft palate repair who continues to experience hypernasality may have this procedure to lengthen the soft palate for better velopharyngeal closure., A patient with submucous cleft palate with insufficient velar length may benefit from this procedure to improve velopharyngeal closure and speech.
Preoperative assessment including speech evaluation,intraoperative notes detailing the type and location of flaps used, postoperative assessment of speech, and any complications.
** The specific surgical technique used may vary.Detailed documentation is crucial for accurate coding.Always verify the code's appropriateness with the specific payer's guidelines.
- Revenue Code: P1G (MAJOR PROCEDURE - OTHER)
- RVU: Not specified in provided text.Refer to current CMS Relative Value Units.
- Global Days : Not specified in the provided text. The global period will depend on payer and other factors.Consult the specific payer's guidelines for this code.
- Payment Status: Active
- Modifier TC rule: Not specified in the provided text. The application of a Technical Component (TC) modifier would depend on the specific circumstances and payer rules. Consult payer guidelines for clarification.
- Fee Schedule : Not specified in provided text.Refer to historical fee schedules from relevant payers for the year in question.
- Specialties:Otolaryngology, Plastic Surgery, Oral and Maxillofacial Surgery
- Place of Service:Ambulatory Surgical Center, Inpatient Hospital, Outpatient Hospital