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

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 Dallas, TX, Medicare pays $239.20 for 42806 in the office and $127.76 when it’s performed in a hospital or facility.

$239.20Office (non-facility)
$127.76Hospital or facility
−0.5%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 Dallas, TX
  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 Dallas, TX 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. Dallas, TX pays $239.20. The RVUs are the same everywhere; the geographic indexes change the dollars.

42806 in Dallas, TX vs other payment areas
  1. Dallas, TX · this page$239.20
  2. Austin, TX · Texas$250.20+$11.00
  3. Beaumont, TX · Texas$223.76−$15.44
  4. Brazoria, TX · Texas$237.67−$1.53
  5. Fort Worth, TX · Texas$237.50−$1.70
  6. Galveston, TX · Texas$238.39−$0.81
  7. Houston, TX · Texas$242.41+$3.21

Other areas in Texas first, then benchmark localities. Bars start at $0.

Every other payment area

42806 in every other Medicare payment locality
Payment localityOfficeFacility
Rest of TexasTexas$230.59$124.41
Los Angeles, CACalifornia$273.14$140.77
Washington, DC areaDistrict of Columbia$276.23$144.42
Miami, FLFlorida$259.10$142.62
Chicago, ILIllinois$251.27$138.82
Manhattan, NYNew York$277.36$147.34
AlaskaAlaska$275.44$156.28
AlabamaAlabama$214.79$116.89

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 Dallas, TX 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

99

Locality
Dallas, TX
Physician work
1.009
Practice expense
0.996
Malpractice
0.858
Office calculation for 42806 in Dallas, TX
ComponentRVULocality factorAdjusted
Physician work1.59× 1.0091.6043
Practice expense5.39× 0.9965.3684
Malpractice0.22× 0.8580.1888
Total RVUs7.1615
Conversion factor× 33.4009

Office rate, Dallas, TX$239.20

Office: (1.59 × 1.009 + 5.39 × 0.996 + 0.22 × 0.858) × $33.4009 = $239.20

Facility: (1.59 × 1.009 + 2.04 × 0.996 + 0.22 × 0.858) × $33.4009 = $127.76

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, Dallas, TX
Same family
42804Nasopharyngeal biopsy, nasopharynxNasopharyngeal sampling by brush or washings rather than directly visualized surgical biopsy.$214.29
Used instead
42800Biopsy, pharynx tissue samplingBiopsy code for a pharyngeal target rather than a nasopharyngeal target.$158.66
42808Pharyngeal lesion treatment, excision or destructionFor excision of a pharyngeal lesion, rather than diagnostic tissue sampling.$232.92

How 42806 has changed in Dallas, TX

42806 · Office / nonfacility

$239.20

Effective 2026-10-01

The base rate is $5.43 higher than on 2025-10-01, moving from $233.77 to $239.20 (2.3%).

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

    $233.77changed to$239.20

    • 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 1.011 changed to 1.009
    • Practice expense GPCI 1.007 changed to 0.996
    • Malpractice GPCI 0.877 changed to 0.858

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $243.54changed to$233.77

    • 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

    $239.57changed to$243.54

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $248.51changed to$239.57

    • Conversion factor 33.8872 changed to 32.7442
    • Malpractice RVU 0.23 changed to 0.24
    • Work GPCI 1.017 changed to 1.011
    • Practice expense GPCI 1.017 changed to 1.007
    • Malpractice GPCI 0.711 changed to 0.877

  5. January 1, 2023

    RVU23A

    $251.65changed to$248.51

    • Conversion factor 34.6062 changed to 33.8872
    • Practice expense RVU 5.34 changed to 5.42
    • Work GPCI 1.023 changed to 1.017
    • Practice expense GPCI 1.026 changed to 1.017
    • Malpractice GPCI 0.546 changed to 0.711

    Held through RVU23B, RVU23C, RVU23D.

  6. January 1, 2022

    RVU22A

    $242.81changed to$251.65

    • 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

    $229.89changed to$242.81

    • 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 1.018 changed to 1.023
    • Practice expense GPCI 1.020 changed to 1.026
    • Malpractice GPCI 0.657 changed to 0.546

    Held through RVU21B, RVU21C, RVU21D.

  8. January 1, 2020

    RVU20A

    $228.71changed to$229.89

    • 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 1.012 changed to 1.018
    • Practice expense GPCI 1.014 changed to 1.020
    • Malpractice GPCI 0.768 changed to 0.657

    Held through RVU20B, RVU20C, RVU20D.

  9. January 1, 2019

    RVU19A

    $224.81changed to$228.71

    • 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

    $226.54changed to$224.81

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 4.42 changed to 4.35
    • Work GPCI 1.015 changed to 1.012
    • Practice expense GPCI 1.012 changed to 1.014
    • Malpractice GPCI 0.770 changed to 0.768

    Held through RVU18B, RVU18C, RVU18D.

  11. January 1, 2017

    RVU17A

    $228.98changed to$226.54

    • Conversion factor 35.8043 changed to 35.8887
    • Practice expense RVU 4.51 changed to 4.42
    • Work GPCI 1.018 changed to 1.015
    • Practice expense GPCI 1.009 changed to 1.012
    • Malpractice GPCI 0.772 changed to 0.770

    Held through RVU17B, RVU17C, RVU17D.

  12. January 1, 2016

    RVU16A

    $227.99changed to$228.98

    • 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

    $226.85changed to$227.99

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  14. January 1, 2015

    RVU15A

    $229.64changed to$226.85

    • 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 1.014 changed to 1.018
    • Practice expense GPCI 1.013 changed to 1.009
    • Malpractice GPCI 0.803 changed to 0.772

    Held through RVU15B.

  15. January 1, 2014

    RVU14A

    $236.59changed to$229.64

    • 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 1.009 changed to 1.014
    • Practice expense GPCI 1.017 changed to 1.013
    • Malpractice GPCI 0.834 changed to 0.803

    Held through RVU14B, RVU14C, RVU14D.

  16. January 1, 2013

    RVU13AR

    Earliest loaded release: $236.59

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$239.20$127.76RVU26D
2026-07-01$239.20$127.76RVU26C
2026-04-01$239.20$127.76RVU26B
2026-01-01$239.20$127.76RVU26A
2025-10-01$233.77$139.31RVU25D
2025-07-01$233.77$139.31RVU25C
2025-04-01$233.77$139.31RVU25B
2025-01-01$233.77$139.31RVU25A
2024-10-01$243.54$143.32RVU24D
2024-07-01$243.54$143.32RVU24C
2024-04-01$243.54$143.32RVU24B
2024-03-09$243.54$143.32RVU24AR
2024-01-01$239.57$140.98RVU24A
2023-10-01$248.51$144.08RVU23D
2023-07-01$248.51$144.08RVU23C
2023-04-01$248.51$144.08RVU23B
2023-01-01$248.51$144.08RVU23A
2022-10-01$251.65$143.72RVU22D
2022-07-01$251.65$143.72RVU22C
2022-04-01$251.65$143.72RVU22B
2022-01-01$251.65$143.72RVU22A
2021-10-01$242.81$138.99RVU21D
2021-07-01$242.81$138.99RVU21C
2021-04-01$242.81$138.99RVU21B
2021-01-01$242.81$138.99RVU21A
2020-10-01$229.89$137.12RVU20D
2020-07-01$229.89$137.12RVU20C
2020-04-01$229.89$137.12RVU20B
2020-01-01$229.89$137.12RVU20A
2019-10-01$228.71$136.99RVU19D
2019-07-01$228.71$136.99RVU19C
2019-04-01$228.71$136.99RVU19B
2019-01-01$228.71$136.99RVU19A
2018-10-01$224.81$135.38RVU18D
2018-07-01$224.81$135.38RVU18C
2018-04-01$224.81$135.38RVU18B
2018-01-01$224.81$135.38RVU18AR1
2017-10-01$226.54$136.10RVU17D
2017-07-01$226.54$136.10RVU17C
2017-04-01$226.54$136.10RVU17B
2017-01-01$226.54$136.10RVU17A
2016-10-01$228.98$137.58RVU16D
2016-07-01$228.98$137.58RVU16C
2016-04-01$228.98$137.58RVU16B
2016-01-01$228.98$137.58RVU16A
2015-10-01$227.99$137.35RVU15D
2015-07-01$227.99$137.35RVU15C
2015-04-01$226.85$136.66RVU15B
2015-01-01$226.85$136.66RVU15A
2014-10-01$229.64$137.46RVU14D
2014-07-01$229.64$137.46RVU14C
2014-04-01$229.64$137.46RVU14B
2014-01-01$229.64$137.46RVU14A
2013-10-01$236.59$138.32RVU13D
2013-07-01$236.59$138.32RVU13C
2013-04-01$236.59$138.32RVU13B
2013-01-01$236.59$138.32RVU13AR

Price 42806 for an earlier date of service

Where the Dallas, TX rate applies

Dallas, TX is a Medicare payment area, not a city. Our Census mapping connects it to 32 cities and communities in Texas. Some span more than one payment area; confirm with the service ZIP.

Browse all communities in Texas

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 Dallas, TXGPCI2026.csv, line 99 (RVU26D)

Open CMS sourceHow we calculate rates

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