42200 Reconstruct cleft palate
Also known as: cleft palate repair, palate repair, cleft palate surgery
Surgical reconstruction of a cleft palate, a congenital developmental defect where the soft palate structures fail to fuse in the midline.
In Plain Language
surgery to fix split in roof of mouth; cleft palate repair
Clinical Context
Primary surgical repair of isolated cleft palate in infants and children, typically performed between 6-12 months of age to restore function and appearance.
RVU Breakdown
| Work RVU | 12.22 |
| Total RVU | 12.22 |
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 90-day global period, which includes the day of the procedure, 1 day preoperative, and 90 days of postoperative care. Ensure the diagnosis code (ICD-10) supports medical necessity for the procedure.
How This Code Compares
With a work RVU of 12.22, this code ranks in the 65th percentile among Surgery codes — 1.5x the median (8.00). The highest wRVU in this category is 106.19.
Specialties
Frequently Asked Questions
What is CPT code 42200?
CPT 42200 (Reconstruct cleft palate) is a Surgery code. Surgical reconstruction of a cleft palate, a congenital developmental defect where the soft palate structures fail to fuse in the midline.
What is the wRVU value for CPT 42200?
The work RVU for CPT 42200 is 12.22. This code is primarily used by Oral Surgery, Plastic Surgery, Pediatric Surgery. It has a 90-day global period.
When is CPT 42200 used?
Primary surgical repair of isolated cleft palate in infants and children, typically performed between 6-12 months of age to restore function and appearance.
Track This Code in RVU Edge
Log procedures, calculate wRVUs, and benchmark against MGMA data — all in one app.
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.