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CPT code 42806: Nasopharyngeal biopsy, directly visualized tissue sampling2026 Medicare rate & RVUs in Washington, DC area

ENT clinicians use this code to obtain tissue from a nasopharyngeal abnormality under direct visualization when surgical biopsy, rather than brush or wash sampling, is performed.

CMS RVU26DEffective Oct 1, 2026One payment locality97 Medicare services in 2024

In Washington, DC area, Medicare pays $276.23 for 42806 in the office and $144.42 when it’s performed in a hospital or facility.

$276.23Office (non-facility)
$144.42Hospital or facility
+14.9%vs the national office rate ($240.49)

Check a contract rate as a % of Medicare · 42806 nationwide

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

We’ll open 42806 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in Washington, DC area
  2. What 42806 covers
  3. Compared with other areas
  4. Rate map
  5. How it’s calculated
  6. Payment rules
  7. Related codes
  8. Rate history
  9. Where it applies
  10. Billing questions
  11. Sources

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.

How Washington, DC area compares for 42806

Across 109 of 109 payment localities, the office rate for 42806 runs from $211.54 in Arkansas to $322.49 in San Benito County, CA. Washington, DC area pays $276.23. The RVUs are the same everywhere; the geographic indexes change the dollars.

42806 in Washington, DC area vs other payment areas
  1. Washington, DC area · this page$276.23
  2. Los Angeles, CA · California$273.14−$3.09
  3. Miami, FL · Florida$259.10−$17.13
  4. Chicago, IL · Illinois$251.27−$24.96
  5. Manhattan, NY · New York$277.36+$1.13
  6. Alaska · Alaska$275.44−$0.79
  7. Alabama · Alabama$214.79−$61.44

Other areas in District of Columbia first, then benchmark localities. Bars start at $0.

Every other payment area

42806 in every other Medicare payment locality
Payment localityOfficeFacility
ArkansasArkansas$211.54$115.42
ArizonaArizona$233.85$125.42
Bakersfield, CACalifornia$255.91$133.27
Chico, CACalifornia$255.26$132.63
El Centro, CACalifornia$255.30$132.66
Fresno, CACalifornia$255.26$132.63
Hanford, CACalifornia$255.26$132.63
Madera, CACalifornia$255.26$132.63

42806 rates by state

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

MEWIVTNHMTNDMNMINYMARIWAIDWYSDIAILINOHPANJCTORNVUTCONEMOKYWVVAMDDECAAZNMKSOKARTNNCSCDCTXLAMSALGAFLAKHI

Explore a state

Local rates. Clear comparisons.

Hover or focus a tile to see its rate range. Select it to open the state’s fee schedule.

$211.54

$288.88

Color shows the midpoint of each state’s locality range.

View every state and territory as a table
42806 office rate range by state
State / territoryOffice rate rangeLocalities
AK$275.441
AL$214.791
AR$211.541
AZ$233.851
CA$255.26–$322.4929
CO$251.041
CT$256.951
DC$276.231
DE$237.851
FL$236.26–$259.103
GA$222.45–$245.002
GU$262.061
HI$262.061
IA$220.751
ID$222.211
IL$228.96–$251.394
IN$223.571
KS$219.561
KY$219.881
LA$219.47–$230.862
MA$249.39–$276.782
MD$242.58–$276.233
ME$223.31–$236.152
MI$225.77–$239.232
MN$240.531
MO$215.45–$231.863
MS$213.541
MT$240.471
NC$225.771
ND$236.121
NE$222.051
NH$246.951
NJ$259.89–$273.142
NM$227.021
NV$239.441
NY$229.30–$284.215
OH$224.881
OK$219.581
OR$237.58–$259.442
PA$225.32–$250.242
PR$242.361
RI$246.641
SC$225.701
SD$235.611
TN$220.701
TX$223.76–$250.208
UT$228.941
VA$235.27–$276.232
VI$242.361
VT$235.061
WA$248.96–$282.662
WI$227.841
WV$220.071
WY$238.581

See 42806 in every payment locality

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.

How the rate is built · 42806

RVUs × geographic indexes × conversion factor

Office or facility?

Work1.59

1.59 RVUs× 1.000 GPCI

Practice expense5.39

5.39 RVUs× 1.000 GPCI

Malpractice0.22

0.22 RVUs× 1.000 GPCI

Adjusted RVUs

7.2000

Conversion factor

$33.4009

Medicare rate

$240.49

Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.

The exact Washington, DC area inputs and CMS source lines

PPRRVU2026_Oct_nonQPP.csv

5,073

Code
42806
Physician work
1.59
Practice expense
5.39
Malpractice
0.22

GPCI2026.csv

39

Locality
Washington, DC area
Physician work
1.054
Practice expense
1.178
Malpractice
1.113
Office calculation for 42806 in Washington, DC area
ComponentRVULocality factorAdjusted
Physician work1.59× 1.0541.6759
Practice expense5.39× 1.1786.3494
Malpractice0.22× 1.1130.2449
Total RVUs8.2701
Conversion factor× 33.4009

Office rate, Washington, DC area$276.23

Office: (1.59 × 1.054 + 5.39 × 1.178 + 0.22 × 1.113) × $33.4009 = $276.23

Facility: (1.59 × 1.054 + 2.04 × 1.178 + 0.22 × 1.113) × $33.4009 = $144.42

Open 42806 in the RVU calculator

Payment rules and modifiers for 42806

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

CMS payment indicators · 42806

Nasopharyngeal biopsy, directly visualized tissue sampling

RuleCMS valueWhat it means
Global period010Minor procedure: the day of the procedure plus 10 days after are included.
Multiple procedures2Standard reduction: highest-valued procedure at 100%, others at 50%.
Bilateral (modifier 50)0The 150% bilateral adjustment doesn’t apply.
Assistant at surgery (80/81/82/AS)1Not paid (statutory restriction).
Co-surgeons (62)0Not permitted.
Team surgery (66)0Not permitted.
Professional/technical0Physician service: no professional/technical split.
Split (54/55/56)0.10/0.80/0.10Share of the payment for pre-op, the procedure itself, and post-op care.

Global surgery period · 42806

Nasopharyngeal biopsy, directly visualized tissue sampling

10-day global period ends

Oct 11, 2026

Covers Oct 1, 2026 through Oct 11, 2026 (11 days).

Visit on Oct 31, 2026

After the global period ends: visits and procedures are billed normally.

SurgeryVisit
Sep 28, 2026Oct 14, 2026

What modifiers do to the payment

Modifier 51 · payment effect

With and without the modifier

42806 without 51 · national office

$240.49

Nasopharyngeal biopsy, directly visualized tissue sampling

42806-51 · Second procedure: 50%

$120.25

When this isn’t the highest-valued procedure in the session, Medicare pays 50% of its fee schedule amount (the highest is paid at 100%).

When to use modifier 51

Codes related to 42806

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

Codes related to 42806
CodeHow it relatesOffice range, Washington, DC area
Same family
42804Nasopharyngeal biopsy, nasopharynxNasopharyngeal sampling by brush or washings rather than directly visualized surgical biopsy.$248.17
Used instead
42800Biopsy, pharynx tissue samplingBiopsy code for a pharyngeal target rather than a nasopharyngeal target.$181.82
42808Pharyngeal lesion treatment, excision or destructionFor excision of a pharyngeal lesion, rather than diagnostic tissue sampling.$265.97

How 42806 has changed in Washington, DC area

42806 · Office / nonfacility

$276.23

Effective 2026-10-01

The base rate is $5.92 higher than on 2025-10-01, moving from $270.31 to $276.23 (2.2%).

It is unchanged from the immediately preceding available release, effective 2026-07-01.

Base rate by release · bars start at $0 · select a bar to compare

One bar per available release, ordered by effective date. Missing rates remain gaps. These comparisons hold the code, setting and locality identifiers constant; they do not isolate which policy or input caused a change.

What changed, release by release

  1. January 1, 2026

    RVU26A

    $270.31changed to$276.23

    • Conversion factor 32.3465 changed to 33.4009
    • Work RVU 1.63 changed to 1.59
    • Practice expense RVU 5.34 changed to 5.39
    • Malpractice RVU 0.23 changed to 0.22
    • Work GPCI 1.057 changed to 1.054
    • Practice expense GPCI 1.192 changed to 1.178
    • Malpractice GPCI 1.168 changed to 1.113

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $281.74changed to$270.31

    • Conversion factor 33.2875 changed to 32.3465
    • Practice expense RVU 5.42 changed to 5.34
    • Malpractice RVU 0.24 changed to 0.23

    Held through RVU25B, RVU25C, RVU25D.

  3. March 9, 2024

    RVU24AR

    $277.14changed to$281.74

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $290.90changed to$277.14

    • Conversion factor 33.8872 changed to 32.7442
    • Malpractice RVU 0.23 changed to 0.24
    • Work GPCI 1.056 changed to 1.057
    • Practice expense GPCI 1.214 changed to 1.192
    • Malpractice GPCI 1.231 changed to 1.168

  5. January 1, 2023

    RVU23A

    $298.16changed to$290.90

    • Conversion factor 34.6062 changed to 33.8872
    • Practice expense RVU 5.34 changed to 5.42
    • Work GPCI 1.054 changed to 1.056
    • Practice expense GPCI 1.236 changed to 1.214
    • Malpractice GPCI 1.294 changed to 1.231

    Held through RVU23B, RVU23C, RVU23D.

  6. January 1, 2022

    RVU22A

    $287.24changed to$298.16

    • Conversion factor 34.8931 changed to 34.6062
    • Practice expense RVU 5.04 changed to 5.34
    • Malpractice RVU 0.22 changed to 0.23

    Held through RVU22B, RVU22C, RVU22D.

  7. January 1, 2021

    RVU21A

    $269.28changed to$287.24

    • Conversion factor 36.0896 changed to 34.8931
    • Practice expense RVU 4.47 changed to 5.04
    • Malpractice RVU 0.23 changed to 0.22
    • Work GPCI 1.049 changed to 1.054
    • Practice expense GPCI 1.221 changed to 1.236
    • Malpractice GPCI 1.277 changed to 1.294

    Held through RVU21B, RVU21C, RVU21D.

  8. January 1, 2020

    RVU20A

    $265.54changed to$269.28

    • Conversion factor 36.0391 changed to 36.0896
    • Practice expense RVU 4.45 changed to 4.47
    • Malpractice RVU 0.24 changed to 0.23
    • Work GPCI 1.045 changed to 1.049
    • Practice expense GPCI 1.205 changed to 1.221
    • Malpractice GPCI 1.261 changed to 1.277

    Held through RVU20B, RVU20C, RVU20D.

  9. January 1, 2019

    RVU19A

    $260.92changed to$265.54

    • Conversion factor 35.9996 changed to 36.0391
    • Practice expense RVU 4.35 changed to 4.45

    Held through RVU19B, RVU19C, RVU19D.

  10. January 1, 2018

    RVU18AR1

    $263.40changed to$260.92

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 4.42 changed to 4.35
    • Work GPCI 1.048 changed to 1.045
    • Malpractice GPCI 1.271 changed to 1.261

    Held through RVU18B, RVU18C, RVU18D.

  11. January 1, 2017

    RVU17A

    $266.92changed to$263.40

    • Conversion factor 35.8043 changed to 35.8887
    • Practice expense RVU 4.51 changed to 4.42
    • Work GPCI 1.051 changed to 1.048
    • Malpractice GPCI 1.280 changed to 1.271

    Held through RVU17B, RVU17C, RVU17D.

  12. January 1, 2016

    RVU16A

    $265.71changed to$266.92

    • Conversion factor 35.9335 changed to 35.8043
    • Practice expense RVU 4.46 changed to 4.51

    Held through RVU16B, RVU16C, RVU16D.

  13. July 1, 2015

    RVU15C

    $264.39changed to$265.71

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  14. January 1, 2015

    RVU15A

    $265.43changed to$264.39

    • Conversion factor 35.8228 changed to 35.7547
    • Practice expense RVU 4.53 changed to 4.46
    • Malpractice RVU 0.21 changed to 0.24
    • Work GPCI 1.050 changed to 1.051
    • Practice expense GPCI 1.202 changed to 1.205
    • Malpractice GPCI 1.205 changed to 1.280

    Held through RVU15B.

  15. January 1, 2014

    RVU14A

    $272.06changed to$265.43

    • Conversion factor 34.0230 changed to 35.8228
    • Practice expense RVU 5.04 changed to 4.53
    • Malpractice RVU 0.22 changed to 0.21
    • Work GPCI 1.049 changed to 1.050
    • Practice expense GPCI 1.198 changed to 1.202
    • Malpractice GPCI 1.130 changed to 1.205

    Held through RVU14B, RVU14C, RVU14D.

  16. January 1, 2013

    RVU13AR

    Earliest loaded release: $272.06

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$276.23$144.42RVU26D
2026-07-01$276.23$144.42RVU26C
2026-04-01$276.23$144.42RVU26B
2026-01-01$276.23$144.42RVU26A
2025-10-01$270.31$158.50RVU25D
2025-07-01$270.31$158.50RVU25C
2025-04-01$270.31$158.50RVU25B
2025-01-01$270.31$158.50RVU25A
2024-10-01$281.74$163.10RVU24D
2024-07-01$281.74$163.10RVU24C
2024-04-01$281.74$163.10RVU24B
2024-03-09$281.74$163.10RVU24AR
2024-01-01$277.14$160.44RVU24A
2023-10-01$290.90$166.25RVU23D
2023-07-01$290.90$166.25RVU23C
2023-04-01$290.90$166.25RVU23B
2023-01-01$290.90$166.25RVU23A
2022-10-01$298.16$168.13RVU22D
2022-07-01$298.16$168.13RVU22C
2022-04-01$298.16$168.13RVU22B
2022-01-01$298.16$168.13RVU22A
2021-10-01$287.24$162.17RVU21D
2021-07-01$287.24$162.17RVU21C
2021-04-01$287.24$162.17RVU21B
2021-01-01$287.24$162.17RVU21A
2020-10-01$269.28$158.24RVU20D
2020-07-01$269.28$158.24RVU20C
2020-04-01$269.28$158.24RVU20B
2020-01-01$269.28$158.24RVU20A
2019-10-01$265.54$156.54RVU19D
2019-07-01$265.54$156.54RVU19C
2019-04-01$265.54$156.54RVU19B
2019-01-01$265.54$156.54RVU19A
2018-10-01$260.92$154.64RVU18D
2018-07-01$260.92$154.64RVU18C
2018-04-01$260.92$154.64RVU18B
2018-01-01$260.92$154.64RVU18AR1
2017-10-01$263.40$155.72RVU17D
2017-07-01$263.40$155.72RVU17C
2017-04-01$263.40$155.72RVU17B
2017-01-01$263.40$155.72RVU17A
2016-10-01$266.92$157.76RVU16D
2016-07-01$266.92$157.76RVU16C
2016-04-01$266.92$157.76RVU16B
2016-01-01$266.92$157.76RVU16A
2015-10-01$265.71$157.47RVU15D
2015-07-01$265.71$157.47RVU15C
2015-04-01$264.39$156.68RVU15B
2015-01-01$264.39$156.68RVU15A
2014-10-01$265.43$156.06RVU14D
2014-07-01$265.43$156.06RVU14C
2014-04-01$265.43$156.06RVU14B
2014-01-01$265.43$156.06RVU14A
2013-10-01$272.06$156.30RVU13D
2013-07-01$272.06$156.30RVU13C
2013-04-01$272.06$156.30RVU13B
2013-01-01$272.06$156.30RVU13AR

Price 42806 for an earlier date of service

Where the Washington, DC area rate applies

Washington, DC area is a Medicare payment area, not a city. Our Census mapping connects it to 1 cities and communities in District of Columbia. Some span more than one payment area; confirm with the service ZIP.

  • Washington

Browse all communities in District of Columbia

42806 billing questions

How do I distinguish this code from 42804?

Use this code for a directly visualized surgical tissue biopsy of the nasopharynx. Code 42804 describes nasopharyngeal sampling by brush or washings.

When is 42800 a better choice?

Code 42800 is for biopsy of the pharynx. Choose this code when the sampled target is in the nasopharynx and the biopsy is performed under direct visualization.

Does excising a lesion support this biopsy code?

A tissue sample taken for diagnosis supports a biopsy. When the procedure removes a pharyngeal lesion rather than sampling it, compare the documentation with code 42808.

What documentation supports reporting this service?

Document the nasopharyngeal site, the abnormality sampled, direct visualization, and the tissue biopsy performed. The note should distinguish tissue sampling from brush or washing collection.

Are postoperative visits included?

Related postoperative visits during the 10-day global period are included in the procedure.

Can modifier 50 be used for bilateral sampling?

No. CMS identifies bilateral adjustment as inappropriate for this service.

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

Show the CMS file lines behind this rate
RVUs for 42806PPRRVU2026_Oct_nonQPP.csv, line 5,073 (RVU26D)
Geographic factors for Washington, DC areaGPCI2026.csv, line 39 (RVU26D)

Open CMS sourceHow we calculate rates

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