How To Use CPT Code 42280

CPT 42280 describes the procedure for taking an impression of the maxillary arch in order to create a palatal prosthesis for patients with a cleft palate. This article will cover the description, official details, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 42280?

CPT 42280 is used to describe the process of taking an impression of the upper intraoral structure, specifically the maxillary arch, to create a palatal prosthesis. This code is typically used for patients with a cleft palate who require a prosthesis to restore speech and feeding functions affected by the condition.

2. Official Description

The official description of CPT code 42280 is: ‘Maxillary impression for palatal prosthesis.’

3. Procedure

1. The provider prepares the patient for the procedure.
2. An impression of the patient’s upper intraoral structure, specifically the maxillary arch, is taken using a specialized material.
3. The impression is used to create molds, which will then be used to fabricate the palatal prosthesis.
4. Great care is taken during the impression process to ensure the accuracy and fit of the prosthesis in the patient’s mouth.
5. The goal of the procedure is to create a prosthesis that restores the function of speech and feeding affected by the presence of a cleft palate.

4. Qualifying circumstances

CPT 42280 is typically performed on patients with a cleft palate, which is a congenital defect characterized by a gap in the palate at its midline, often occurring in conjunction with a cleft lip. The procedure is performed by a provider to create a palatal prosthesis that helps restore normal function in speech and feeding.

5. When to use CPT code 42280

CPT code 42280 should be used when a provider performs the procedure to take an impression of the maxillary arch for the purpose of creating a palatal prosthesis. It is important to note that this code should not be used for the insertion of a prosthesis prepared by an outside lab or for other types of palatal augmentation or lift prostheses.

6. Documentation requirements

To support a claim for CPT 42280, the provider must document the following information:

• Patient’s diagnosis and the need for a palatal prosthesis
• Date of the procedure
• Details of the procedure, including the use of specialized materials
• Any additional relevant information or complications encountered during the procedure
• Signature of the provider performing the procedure

7. Billing guidelines

When billing for CPT 42280, ensure that the procedure is performed to take an impression of the maxillary arch for a palatal prosthesis. It is important to follow the specific guidelines and requirements set by the payer. Additionally, be aware of other related codes that may be applicable in different scenarios, such as insertion of pin retained palatal prosthesis (CPT 42281) or impression and custom preparation for palatal augmentation prosthesis (CPT 21082) or palatal lift prosthesis (CPT 21083).

8. Historical information

CPT 42280 was added to the Current Procedural Terminology system on January 1, 1990. There have been no updates or changes to the code since its addition.

9. Examples

1. A provider takes an impression of the maxillary arch to create a palatal prosthesis for a patient with a cleft palate.
2. A dentist performs the procedure to take an impression of the maxillary arch for a palatal prosthesis in a patient with a cleft palate.
3. A maxillofacial surgeon uses specialized materials to take an impression of the maxillary arch for a palatal prosthesis in a patient with a cleft palate.
4. An orthodontist performs the procedure to create molds for a palatal prosthesis in a patient with a cleft palate.
5. A prosthodontist takes an impression of the maxillary arch to fabricate a palatal prosthesis for a patient with a cleft palate.