CPT 42281
Insertion palate prosthesis
CPT 42281 at a glance
- Code
- 42281
- Code type
- CPT/HCPCS
- Short descriptor
- Insertion palate prosthesis
- Category
- ASC Surgical
- ASC eligibility
- ASC-eligible (surgical)
- Typical setting
- Ambulatory surgery center (POS 24) or hospital outpatient department (POS 22).
- Medicare ASC rate
- $3,025.62 national · 2026Q2
What is CPT code 42281?
CPT 42281 is a CPT/HCPCS procedure code. Its official short descriptor is "Insertion palate prosthesis". In the ASC context it is grouped under ASC Surgical.
Is CPT 42281 eligible in an ambulatory surgery center (ASC)?
CPT 42281 can be performed in a certified ambulatory surgery center.
Where is CPT 42281 typically performed?
Ambulatory surgery center (POS 24) or hospital outpatient department (POS 22).
What is the Medicare ASC payment rate for CPT 42281?
The national Medicare ASC payment rate for CPT 42281 is $3,025.62 (CMS ASC Payment System, 2026Q2). This is the national, unadjusted amount published by CMS; the amount an individual ambulatory surgery center is paid is adjusted for local wage index and may differ. It reflects Medicare's facility payment only and does not include the surgeon's professional fee.
Which specialties use CPT 42281?
CPT 42281 is most associated with General Surgery.
Reference information about ASC eligibility and typical procedure setting. Codes, descriptors, and ASC-eligibility status change over time. This is a coding reference, not billing, coding, or legal advice. Always verify against current guidance and individual payer policy before scheduling or billing. CPT is a registered trademark of the American Medical Association.