42160 Treatment mouth roof lesion
Also known as: palatal lesion treatment
Surgical treatment of a lesion on the roof of the mouth or palate, including removal, cauterization, or other therapeutic intervention.
In Plain Language
treatment of sore or growth on roof of mouth
Clinical Context
Used for benign lesions, ulcers, or small growths on hard or soft palate requiring therapeutic intervention without full excision.
RVU Breakdown
| Work RVU | 1.80 |
| Total RVU | 1.80 |
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 1.80, this code ranks in the 12th percentile among Surgery codes — 4.4x below the median (8.00). The highest wRVU in this category is 106.19.
Specialties
Frequently Asked Questions
What is CPT code 42160?
CPT 42160 (Treatment mouth roof lesion) is a Surgery code. Surgical treatment of a lesion on the roof of the mouth or palate, including removal, cauterization, or other therapeutic intervention.
What is the wRVU value for CPT 42160?
The work RVU for CPT 42160 is 1.80. This code is primarily used by Oral Surgery, Dentistry. It has a 10-day global period.
When is CPT 42160 used?
Used for benign lesions, ulcers, or small growths on hard or soft palate requiring therapeutic intervention without full excision.
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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.