42260 Repair nose to lip fistula
Also known as: fistula repair, oro-nasal fistula closure
Surgical repair of an oronasal fistula, an abnormal communication between the mouth and nasal cavity, by primary closure or tissue reconstruction.
In Plain Language
repair of hole between mouth and nose
Clinical Context
Surgical correction of fistula from cleft palate, trauma, infection, or post-operative complications affecting palate and nasal structures.
RVU Breakdown
| Work RVU | 9.96 |
| Total RVU | 9.96 |
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 9.96, this code ranks in the 59th percentile among Surgery codes — 1.2x the median (8.00). The highest wRVU in this category is 106.19.
Specialties
Frequently Asked Questions
What is CPT code 42260?
CPT 42260 (Repair nose to lip fistula) is a Surgery code. Surgical repair of an oronasal fistula, an abnormal communication between the mouth and nasal cavity, by primary closure or tissue reconstruction.
What is the wRVU value for CPT 42260?
The work RVU for CPT 42260 is 9.96. This code is primarily used by Oral Surgery, Plastic Surgery. It has a 90-day global period.
When is CPT 42260 used?
Surgical correction of fistula from cleft palate, trauma, infection, or post-operative complications affecting palate and nasal structures.
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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.