42100 Biopsy roof of mouth
Also known as: palate biopsy, palatal biopsy
Surgical procedure to obtain a tissue sample through biopsy from the mucous membrane of the roof of the mouth (hard palate or soft palate).
In Plain Language
biopsy of roof of mouth; tissue sample from hard or soft palate
Clinical Context
Diagnostic procedure performed when suspicious lesions appear on palate to establish histologic diagnosis of ulcers, masses, or other pathology.
RVU Breakdown
| Work RVU | 1.33 |
| Total RVU | 1.33 |
Est. Medicare Payment
National estimate based on 2026 CMS PFS Conversion Factor ($33.40). Actual payment varies by locality (GPCI adjustment).
Billing & Documentation
As a surgical CPT code, proper documentation must include the operative report detailing the procedure performed, patient positioning, approach, findings, and any complications. This code has a 10-day global period — follow-up visits within 10 days of the procedure are included in the reimbursement. Ensure the diagnosis code (ICD-10) supports medical necessity for the procedure.
How This Code Compares
With a work RVU of 1.33, this code ranks in the 7th percentile among Surgery codes — 6.0x below the median (8.00). The highest wRVU in this category is 106.19.
Specialties
Frequently Asked Questions
What is CPT code 42100?
CPT 42100 (Biopsy roof of mouth) is a Surgery code. Surgical procedure to obtain a tissue sample through biopsy from the mucous membrane of the roof of the mouth (hard palate or soft palate).
What is the wRVU value for CPT 42100?
The work RVU for CPT 42100 is 1.33. This code is primarily used by Oral Surgery, Dentistry, Pathology. It has a 10-day global period.
When is CPT 42100 used?
Diagnostic procedure performed when suspicious lesions appear on palate to establish histologic diagnosis of ulcers, masses, or other pathology.
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CPT® is a registered trademark of the American Medical Association. Data sourced from CMS Physician Fee Schedule RVU26A. Descriptions, synonyms, and clinical context are original content by RVU Edge.