CPT code 42806: Nasopharyngeal biopsy, directly visualized tissue sampling2026 Medicare rate & RVUs in North Carolina
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.
In North Carolina, Medicare pays $225.77 for 42806 in the office and $121.38 when it’s performed in a hospital or facility.
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.
On this page 11 sections
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 North Carolina 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. North Carolina pays $225.77. The RVUs are the same everywhere; the geographic indexes change the dollars.
- North Carolina · this page$225.77
- Los Angeles, CA · California$273.14+$47.37
- Washington, DC area · District of Columbia$276.23+$50.46
- Miami, FL · Florida$259.10+$33.33
- Chicago, IL · Illinois$251.27+$25.50
- Manhattan, NY · New York$277.36+$51.59
- Alaska · Alaska$275.44+$49.67
Other areas in North Carolina first, then benchmark localities. Bars start at $0.
Every other payment area
| Payment locality | Office | Facility |
|---|---|---|
| AlabamaAlabama | $214.79 | $116.89 |
| 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 |
| Merced, CACalifornia | $255.26 | $132.63 |
| Modesto, CACalifornia | $255.26 | $132.63 |
| Napa, CACalifornia | $297.47 | $149.99 |
| Oxnard, CACalifornia | $271.97 | $139.71 |
| Redding, CACalifornia | $255.26 | $132.63 |
| Rest of CaliforniaCalifornia | $255.26 | $132.63 |
| Riverside, CACalifornia | $257.65 | $135.01 |
| Sacramento, CACalifornia | $268.33 | $138.20 |
| Salinas, CACalifornia | $267.35 | $137.66 |
| San Diego, CACalifornia | $274.00 | $140.18 |
| Marin County, CACalifornia | $315.37 | $157.60 |
| San Francisco, CACalifornia | $315.12 | $157.35 |
| San Benito County, CACalifornia | $322.49 | $161.14 |
| Santa Clara County, CACalifornia | $321.47 | $160.12 |
| San Luis Obispo, CACalifornia | $263.00 | $135.56 |
| Santa Cruz, CACalifornia | $276.90 | $140.95 |
| Santa Maria, CACalifornia | $268.45 | $137.98 |
| Santa Rosa, CACalifornia | $279.72 | $142.31 |
| Stockton, CACalifornia | $255.26 | $132.63 |
| Vallejo, CACalifornia | $297.11 | $149.63 |
| Visalia, CACalifornia | $255.26 | $132.63 |
| Yuba City, CACalifornia | $255.26 | $132.63 |
| ColoradoColorado | $251.04 | $131.98 |
| ConnecticutConnecticut | $256.95 | $136.45 |
| DelawareDelaware | $237.85 | $127.30 |
| Fort Lauderdale, FLFlorida | $248.76 | $135.42 |
| Rest of FloridaFlorida | $236.26 | $129.29 |
| Atlanta, GAGeorgia | $245.00 | $131.32 |
| Rest of GeorgiaGeorgia | $222.45 | $122.65 |
| Hawaii, Guam, HIHawaii | $262.06 | $134.83 |
| IowaIowa | $220.75 | $118.37 |
| IdahoIdaho | $222.21 | $119.27 |
| East St. Louis, ILIllinois | $233.54 | $130.59 |
| Rest of IllinoisIllinois | $228.96 | $126.80 |
| Suburban Chicago, ILIllinois | $251.39 | $136.48 |
| IndianaIndiana | $223.57 | $119.84 |
| KansasKansas | $219.56 | $118.41 |
| KentuckyKentucky | $219.88 | $120.41 |
| New Orleans, LALouisiana | $230.86 | $125.57 |
| Rest of LouisianaLouisiana | $219.47 | $120.45 |
| Metropolitan Boston, MAMassachusetts | $276.78 | $143.18 |
| Rest of MassachusettsMassachusetts | $249.39 | $131.56 |
| Baltimore area, MDMaryland | $256.22 | $136.16 |
| Rest of MarylandMaryland | $242.58 | $129.34 |
| Rest of MaineMaine | $223.31 | $120.36 |
| Southern Maine, MEMaine | $236.15 | $125.27 |
| Detroit, MIMichigan | $239.23 | $131.25 |
| Rest of MichiganMichigan | $225.77 | $123.61 |
| MinnesotaMinnesota | $240.53 | $125.40 |
| Metropolitan Kansas City, MOMissouri | $229.34 | $124.27 |
| Metropolitan St. Louis, MOMissouri | $231.86 | $125.34 |
| Rest of MissouriMissouri | $215.45 | $119.00 |
| MississippiMississippi | $213.54 | $117.20 |
| MontanaMontana | $240.47 | $128.58 |
| North DakotaNorth Dakota | $236.12 | $124.23 |
| NebraskaNebraska | $222.05 | $118.78 |
| New HampshireNew Hampshire | $246.95 | $130.47 |
| Northern New JerseyNew Jersey | $273.14 | $143.34 |
| Rest of New JerseyNew Jersey | $259.89 | $137.70 |
| New MexicoNew Mexico | $227.02 | $124.42 |
| NevadaNevada | $239.44 | $127.43 |
| NYC suburbs and Long Island, NYNew York | $284.21 | $151.17 |
| Poughkeepsie and northern NYC suburbs, NYNew York | $261.52 | $139.00 |
| Queens, NYNew York | $279.90 | $147.64 |
| Rest of New YorkNew York | $229.30 | $123.00 |
| OhioOhio | $224.88 | $122.72 |
| OklahomaOklahoma | $219.58 | $119.66 |
| Portland, OROregon | $259.44 | $135.13 |
| Rest of OregonOregon | $237.58 | $126.14 |
| Metropolitan Philadelphia, PAPennsylvania | $250.24 | $133.76 |
| Rest of PennsylvaniaPennsylvania | $225.32 | $122.60 |
| Puerto RicoPuerto Rico | $242.36 | $129.23 |
| Rhode IslandRhode Island | $246.64 | $131.06 |
| South CarolinaSouth Carolina | $225.70 | $122.31 |
| South DakotaSouth Dakota | $235.61 | $123.71 |
| TennesseeTennessee | $220.70 | $118.99 |
| Austin, TXTexas | $250.20 | $131.81 |
| Beaumont, TXTexas | $223.76 | $121.94 |
| Brazoria, TXTexas | $237.67 | $126.79 |
| Dallas, TXTexas | $239.20 | $127.76 |
| Fort Worth, TXTexas | $237.50 | $127.17 |
| Galveston, TXTexas | $238.39 | $127.28 |
| Houston, TXTexas | $242.41 | $131.30 |
| Rest of TexasTexas | $230.59 | $124.41 |
| UtahUtah | $228.94 | $123.76 |
| VirginiaVirginia | $235.27 | $125.27 |
| Virgin Islands, VIUnited States Virgin Islands | $242.36 | $129.23 |
| VermontVermont | $235.06 | $124.28 |
| Rest of WashingtonWashington | $248.96 | $131.14 |
| King County, WAWashington | $282.66 | $145.37 |
| WisconsinWisconsin | $227.84 | $120.65 |
| West VirginiaWest Virginia | $220.07 | $122.83 |
| WyomingWyoming | $238.58 | $126.68 |
42806 rates by state
Office rate range in each state. Select a state to see its payment localities.
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
| State / territory | Office rate range | Localities |
|---|---|---|
| AK | $275.44 | 1 |
| AL | $214.79 | 1 |
| AR | $211.54 | 1 |
| AZ | $233.85 | 1 |
| CA | $255.26–$322.49 | 29 |
| CO | $251.04 | 1 |
| CT | $256.95 | 1 |
| DC | $276.23 | 1 |
| DE | $237.85 | 1 |
| FL | $236.26–$259.10 | 3 |
| GA | $222.45–$245.00 | 2 |
| GU | $262.06 | 1 |
| HI | $262.06 | 1 |
| IA | $220.75 | 1 |
| ID | $222.21 | 1 |
| IL | $228.96–$251.39 | 4 |
| IN | $223.57 | 1 |
| KS | $219.56 | 1 |
| KY | $219.88 | 1 |
| LA | $219.47–$230.86 | 2 |
| MA | $249.39–$276.78 | 2 |
| MD | $242.58–$276.23 | 3 |
| ME | $223.31–$236.15 | 2 |
| MI | $225.77–$239.23 | 2 |
| MN | $240.53 | 1 |
| MO | $215.45–$231.86 | 3 |
| MS | $213.54 | 1 |
| MT | $240.47 | 1 |
| NC | $225.77 | 1 |
| ND | $236.12 | 1 |
| NE | $222.05 | 1 |
| NH | $246.95 | 1 |
| NJ | $259.89–$273.14 | 2 |
| NM | $227.02 | 1 |
| NV | $239.44 | 1 |
| NY | $229.30–$284.21 | 5 |
| OH | $224.88 | 1 |
| OK | $219.58 | 1 |
| OR | $237.58–$259.44 | 2 |
| PA | $225.32–$250.24 | 2 |
| PR | $242.36 | 1 |
| RI | $246.64 | 1 |
| SC | $225.70 | 1 |
| SD | $235.61 | 1 |
| TN | $220.70 | 1 |
| TX | $223.76–$250.20 | 8 |
| UT | $228.94 | 1 |
| VA | $235.27–$276.23 | 2 |
| VI | $242.36 | 1 |
| VT | $235.06 | 1 |
| WA | $248.96–$282.66 | 2 |
| WI | $227.84 | 1 |
| WV | $220.07 | 1 |
| WY | $238.58 | 1 |
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
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 North Carolina 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
83
- Locality
- North Carolina
- Physician work
- 1.000
- Practice expense
- 0.933
- Malpractice
- 0.639
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 1.59 | × 1.000 | 1.5900 |
| Practice expense | 5.39 | × 0.933 | 5.0289 |
| Malpractice | 0.22 | × 0.639 | 0.1406 |
| Total RVUs | 6.7595 | ||
| Conversion factor | × 33.4009 | ||
Office rate, North Carolina$225.77
Office: (1.59 × 1 + 5.39 × 0.933 + 0.22 × 0.639) × $33.4009 = $225.77
Facility: (1.59 × 1 + 2.04 × 0.933 + 0.22 × 0.639) × $33.4009 = $121.38
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
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 010 | Minor procedure: the day of the procedure plus 10 days after are included. |
| Multiple procedures | 2 | Standard reduction: highest-valued procedure at 100%, others at 50%. |
| Bilateral (modifier 50) | 0 | The 150% bilateral adjustment doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 1 | Not paid (statutory restriction). |
| Co-surgeons (62) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
| Split (54/55/56) | 0.10/0.80/0.10 | Share 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.
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%).
How 42806 has changed in North Carolina
42806 · Office / nonfacility
$225.77
Effective 2026-10-01
The base rate is $8.15 higher than on 2025-10-01, moving from $217.62 to $225.77 (3.7%).
It is unchanged from the immediately preceding available release, effective 2026-07-01.
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
January 1, 2026
RVU26A
$217.62changed to$225.77
- 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
- Practice expense GPCI 0.926 changed to 0.933
- Malpractice GPCI 0.665 changed to 0.639
Held through RVU26B, RVU26C, RVU26D.
January 1, 2025
RVU25A
$226.64changed to$217.62
- 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.
March 9, 2024
RVU24AR
$222.94changed to$226.64
- Conversion factor 32.7442 changed to 33.2875
Held through RVU24B, RVU24C, RVU24D.
January 1, 2024
RVU24A
$231.28changed to$222.94
- Conversion factor 33.8872 changed to 32.7442
- Malpractice RVU 0.23 changed to 0.24
- Practice expense GPCI 0.927 changed to 0.926
- Malpractice GPCI 0.742 changed to 0.665
January 1, 2023
RVU23A
$234.42changed to$231.28
- Conversion factor 34.6062 changed to 33.8872
- Practice expense RVU 5.34 changed to 5.42
- Practice expense GPCI 0.928 changed to 0.927
- Malpractice GPCI 0.819 changed to 0.742
Held through RVU23B, RVU23C, RVU23D.
January 1, 2022
RVU22A
$226.36changed to$234.42
- 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.
January 1, 2021
RVU21A
$215.14changed to$226.36
- 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
- Practice expense GPCI 0.930 changed to 0.928
- Malpractice GPCI 0.757 changed to 0.819
Held through RVU21B, RVU21C, RVU21D.
January 1, 2020
RVU20A
$214.06changed to$215.14
- 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
- Practice expense GPCI 0.931 changed to 0.930
- Malpractice GPCI 0.695 changed to 0.757
Held through RVU20B, RVU20C, RVU20D.
January 1, 2019
RVU19A
$210.48changed to$214.06
- Conversion factor 35.9996 changed to 36.0391
- Practice expense RVU 4.35 changed to 4.45
Held through RVU19B, RVU19C, RVU19D.
January 1, 2018
RVU18AR1
$212.49changed to$210.48
- Conversion factor 35.8887 changed to 35.9996
- Practice expense RVU 4.42 changed to 4.35
- Malpractice GPCI 0.732 changed to 0.695
Held through RVU18B, RVU18C, RVU18D.
January 1, 2017
RVU17A
$215.13changed to$212.49
- Conversion factor 35.8043 changed to 35.8887
- Practice expense RVU 4.51 changed to 4.42
- Practice expense GPCI 0.930 changed to 0.931
- Malpractice GPCI 0.768 changed to 0.732
Held through RVU17B, RVU17C, RVU17D.
January 1, 2016
RVU16A
$214.24changed to$215.13
- Conversion factor 35.9335 changed to 35.8043
- Practice expense RVU 4.46 changed to 4.51
Held through RVU16B, RVU16C, RVU16D.
July 1, 2015
RVU15C
$213.17changed to$214.24
- Conversion factor 35.7547 changed to 35.9335
Held through RVU15D.
January 1, 2015
RVU15A
$214.65changed to$213.17
- 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
- Practice expense GPCI 0.929 changed to 0.930
- Malpractice GPCI 0.732 changed to 0.768
Held through RVU15B.
January 1, 2014
RVU14A
$219.62changed to$214.65
- 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
- Practice expense GPCI 0.927 changed to 0.929
- Malpractice GPCI 0.695 changed to 0.732
Held through RVU14B, RVU14C, RVU14D.
January 1, 2013
RVU13AR
Earliest loaded release: $219.62
Held through RVU13B, RVU13C, RVU13D.
| Effective from | Office | Facility | CMS release |
|---|---|---|---|
| 2026-10-01 | $225.77 | $121.38 | RVU26D |
| 2026-07-01 | $225.77 | $121.38 | RVU26C |
| 2026-04-01 | $225.77 | $121.38 | RVU26B |
| 2026-01-01 | $225.77 | $121.38 | RVU26A |
| 2025-10-01 | $217.62 | $130.76 | RVU25D |
| 2025-07-01 | $217.62 | $130.76 | RVU25C |
| 2025-04-01 | $217.62 | $130.76 | RVU25B |
| 2025-01-01 | $217.62 | $130.76 | RVU25A |
| 2024-10-01 | $226.64 | $134.47 | RVU24D |
| 2024-07-01 | $226.64 | $134.47 | RVU24C |
| 2024-04-01 | $226.64 | $134.47 | RVU24B |
| 2024-03-09 | $226.64 | $134.47 | RVU24AR |
| 2024-01-01 | $222.94 | $132.28 | RVU24A |
| 2023-10-01 | $231.28 | $136.10 | RVU23D |
| 2023-07-01 | $231.28 | $136.10 | RVU23C |
| 2023-04-01 | $231.28 | $136.10 | RVU23B |
| 2023-01-01 | $231.28 | $136.10 | RVU23A |
| 2022-10-01 | $234.42 | $136.79 | RVU22D |
| 2022-07-01 | $234.42 | $136.79 | RVU22C |
| 2022-04-01 | $234.42 | $136.79 | RVU22B |
| 2022-01-01 | $234.42 | $136.79 | RVU22A |
| 2021-10-01 | $226.36 | $132.46 | RVU21D |
| 2021-07-01 | $226.36 | $132.46 | RVU21C |
| 2021-04-01 | $226.36 | $132.46 | RVU21B |
| 2021-01-01 | $226.36 | $132.46 | RVU21A |
| 2020-10-01 | $215.14 | $130.56 | RVU20D |
| 2020-07-01 | $215.14 | $130.56 | RVU20C |
| 2020-04-01 | $215.14 | $130.56 | RVU20B |
| 2020-01-01 | $215.14 | $130.56 | RVU20A |
| 2019-10-01 | $214.06 | $129.85 | RVU19D |
| 2019-07-01 | $214.06 | $129.85 | RVU19C |
| 2019-04-01 | $214.06 | $129.85 | RVU19B |
| 2019-01-01 | $214.06 | $129.85 | RVU19A |
| 2018-10-01 | $210.48 | $128.36 | RVU18D |
| 2018-07-01 | $210.48 | $128.36 | RVU18C |
| 2018-04-01 | $210.48 | $128.36 | RVU18B |
| 2018-01-01 | $210.48 | $128.36 | RVU18AR1 |
| 2017-10-01 | $212.49 | $129.29 | RVU17D |
| 2017-07-01 | $212.49 | $129.29 | RVU17C |
| 2017-04-01 | $212.49 | $129.29 | RVU17B |
| 2017-01-01 | $212.49 | $129.29 | RVU17A |
| 2016-10-01 | $215.13 | $130.89 | RVU16D |
| 2016-07-01 | $215.13 | $130.89 | RVU16C |
| 2016-04-01 | $215.13 | $130.89 | RVU16B |
| 2016-01-01 | $215.13 | $130.89 | RVU16A |
| 2015-10-01 | $214.24 | $130.69 | RVU15D |
| 2015-07-01 | $214.24 | $130.69 | RVU15C |
| 2015-04-01 | $213.17 | $130.04 | RVU15B |
| 2015-01-01 | $213.17 | $130.04 | RVU15A |
| 2014-10-01 | $214.65 | $130.12 | RVU14D |
| 2014-07-01 | $214.65 | $130.12 | RVU14C |
| 2014-04-01 | $214.65 | $130.12 | RVU14B |
| 2014-01-01 | $214.65 | $130.12 | RVU14A |
| 2013-10-01 | $219.62 | $130.05 | RVU13D |
| 2013-07-01 | $219.62 | $130.05 | RVU13C |
| 2013-04-01 | $219.62 | $130.05 | RVU13B |
| 2013-01-01 | $219.62 | $130.05 | RVU13AR |
Where the North Carolina rate applies
North Carolina is a Medicare payment area, not a city. Our Census mapping connects it to 785 cities and communities in North Carolina. Some span more than one payment area; confirm with the service ZIP.
- Aberdeen
- Advance
- Ahoskie
- Alamance
- Albemarle
- Alexis
- Alliance
- Altamahaw
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
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