CPT code 42806: Nasopharyngeal biopsy, directly visualized tissue sampling2026 Medicare rate & RVUs

Medicare pays $240.49 for 42806 nationally in the office and $128.59 in a hospital or facility. Local office rates run $211.54–$322.49.

Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.

What 42806 covers

An otolaryngologist uses directly visualized surgical instruments to obtain tissue from an abnormal area in the nasopharynx, the space behind the nasal cavity and above the soft palate. Typical indications include a visible mass, irregular mucosa, or other suspicious finding requiring tissue diagnosis. The procedure may be performed in an operating room or another setting where the clinician can directly visualize and sample the target.

Choose this code for a nasopharyngeal tissue biopsy performed under direct visualization; brush or washing-based sampling is represented by a different code. The operative note should identify the nasopharyngeal target, the direct-visualization approach, and the tissue sampling performed. Medicare includes related postoperative visits for 10 days in the procedure’s global period. When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% multiple-procedure reduction. Medicare does not pay an assistant at surgery for this service, and co-surgeon and team-surgery billing are not permitted.

This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.

Where 42806 pays more and less

The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.

109 of 109 payment localities

42806 rates by state

Office rate range in each state. Select a state to see its payment localities.

How the 42806 rate is calculated

Each of 42806’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.

Payment rules and modifiers for 42806

42806 has a 10-day global period: related visits in that window are included in the surgery payment.

What modifiers do to the payment

When to use modifier 51

42806 compared with similar codes

How to choose

42804Nasopharyngeal biopsyNasopharynx

42804 describes brush or washing collection from the nasopharynx. This code is for a tissue biopsy performed under direct visualization.

42800BiopsyPharynx tissue sampling

42800 applies to a pharyngeal biopsy. Use this code when the sampled site is in the nasopharynx.

42808Pharyngeal lesion treatmentExcision or destruction

42808 describes excision of a pharyngeal lesion. This code is for biopsy sampling of a nasopharyngeal abnormality.

Codes related to 42806

Related codes aren’t interchangeable: bill the code that matches the service performed.

Where these rates come from

FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.

CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027

Open CMS sourceHow we calculate rates