CPT 42281
Insertion palate prosthesis
Last reviewed August 2026 · DataLily AI data team
Pilot Analysis
Get the complete CPT 42281 analysis
Tell us where to send it. Our team will prepare an analysis of CPT 42281 covering what payers reimburse across markets and where your rate may sit, and email it to you within 5-10 business days. Need it faster? Book a demo.
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 for insertion palate prosthesis. 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 (Medicare ASC Payment System, 2026Q2). This is the national, unadjusted Medicare amount; 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. Read the DataLily AI data methodology.