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CPT code 42806: Nasopharyngeal biopsy, directly visualized tissue sampling2026 Medicare rate & RVUs in Houston, 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 Houston, TX, Medicare pays $242.41 for 42806 in the office and $131.30 when it’s performed in a hospital or facility.

$242.41Office (non-facility)
$131.30Hospital or facility
+0.8%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 Houston, 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 Houston, 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. Houston, TX pays $242.41. The RVUs are the same everywhere; the geographic indexes change the dollars.

42806 in Houston, TX vs other payment areas
  1. Houston, TX · this page$242.41
  2. Austin, TX · Texas$250.20+$7.79
  3. Beaumont, TX · Texas$223.76−$18.65
  4. Brazoria, TX · Texas$237.67−$4.74
  5. Dallas, TX · Texas$239.20−$3.21
  6. Fort Worth, TX · Texas$237.50−$4.91
  7. Galveston, TX · Texas$238.39−$4.02

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 Houston, 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

102

Locality
Houston, TX
Physician work
1.008
Practice expense
0.993
Malpractice
1.376
Office calculation for 42806 in Houston, TX
ComponentRVULocality factorAdjusted
Physician work1.59× 1.0081.6027
Practice expense5.39× 0.9935.3523
Malpractice0.22× 1.3760.3027
Total RVUs7.2577
Conversion factor× 33.4009

Office rate, Houston, TX$242.41

Office: (1.59 × 1.008 + 5.39 × 0.993 + 0.22 × 1.376) × $33.4009 = $242.41

Facility: (1.59 × 1.008 + 2.04 × 0.993 + 0.22 × 1.376) × $33.4009 = $131.30

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, Houston, TX
Same family
42804Nasopharyngeal biopsy, nasopharynxNasopharyngeal sampling by brush or washings rather than directly visualized surgical biopsy.$216.86
Used instead
42800Biopsy, pharynx tissue samplingBiopsy code for a pharyngeal target rather than a nasopharyngeal target.$161.93
42808Pharyngeal lesion treatment, excision or destructionFor excision of a pharyngeal lesion, rather than diagnostic tissue sampling.$238.46

How 42806 has changed in Houston, TX

42806 · Office / nonfacility

$242.41

Effective 2026-10-01

The base rate is $5.22 higher than on 2025-10-01, moving from $237.19 to $242.41 (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

    $237.19changed to$242.41

    • 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 1.014 changed to 1.008
    • Practice expense GPCI 1.003 changed to 0.993
    • Malpractice GPCI 1.409 changed to 1.376

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $247.23changed to$237.19

    • 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

    $243.20changed to$247.23

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $252.11changed to$243.20

    • Conversion factor 33.8872 changed to 32.7442
    • Malpractice RVU 0.23 changed to 0.24
    • Work GPCI 1.023 changed to 1.014
    • Practice expense GPCI 1.016 changed to 1.003
    • Malpractice GPCI 1.154 changed to 1.409

  5. January 1, 2023

    RVU23A

    $255.53changed to$252.11

    • Conversion factor 34.6062 changed to 33.8872
    • Practice expense RVU 5.34 changed to 5.42
    • Work GPCI 1.032 changed to 1.023
    • Practice expense GPCI 1.029 changed to 1.016
    • Malpractice GPCI 0.900 changed to 1.154

    Held through RVU23B, RVU23C, RVU23D.

  6. January 1, 2022

    RVU22A

    $246.57changed to$255.53

    • 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

    $232.52changed to$246.57

    • 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 1.026 changed to 1.032
    • Practice expense GPCI 1.020 changed to 1.029
    • Malpractice GPCI 0.918 changed to 0.900

    Held through RVU21B, RVU21C, RVU21D.

  8. January 1, 2020

    RVU20A

    $230.31changed to$232.52

    • 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 1.020 changed to 1.026
    • Practice expense GPCI 1.012 changed to 1.020
    • Malpractice GPCI 0.936 changed to 0.918

    Held through RVU20B, RVU20C, RVU20D.

  9. January 1, 2019

    RVU19A

    $226.42changed to$230.31

    • 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

    $227.87changed to$226.42

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 4.42 changed to 4.35
    • Practice expense GPCI 1.009 changed to 1.012
    • Malpractice GPCI 0.946 changed to 0.936

    Held through RVU18B, RVU18C, RVU18D.

  11. January 1, 2017

    RVU17A

    $230.12changed to$227.87

    • Conversion factor 35.8043 changed to 35.8887
    • Practice expense RVU 4.51 changed to 4.42
    • Work GPCI 1.019 changed to 1.020
    • Practice expense GPCI 1.006 changed to 1.009
    • Malpractice GPCI 0.955 changed to 0.946

    Held through RVU17B, RVU17C, RVU17D.

  12. January 1, 2016

    RVU16A

    $229.15changed to$230.12

    • 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

    $228.01changed to$229.15

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  14. January 1, 2015

    RVU15A

    $229.20changed to$228.01

    • 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 1.019
    • Practice expense GPCI 1.004 changed to 1.006
    • Malpractice GPCI 0.939 changed to 0.955

    Held through RVU15B.

  15. January 1, 2014

    RVU14A

    $234.68changed to$229.20

    • 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 1.002 changed to 1.004
    • Malpractice GPCI 0.923 changed to 0.939

    Held through RVU14B, RVU14C, RVU14D.

  16. January 1, 2013

    RVU13AR

    Earliest loaded release: $234.68

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$242.41$131.30RVU26D
2026-07-01$242.41$131.30RVU26C
2026-04-01$242.41$131.30RVU26B
2026-01-01$242.41$131.30RVU26A
2025-10-01$237.19$143.11RVU25D
2025-07-01$237.19$143.11RVU25C
2025-04-01$237.19$143.11RVU25B
2025-01-01$237.19$143.11RVU25A
2024-10-01$247.23$147.41RVU24D
2024-07-01$247.23$147.41RVU24C
2024-04-01$247.23$147.41RVU24B
2024-03-09$247.23$147.41RVU24AR
2024-01-01$243.20$145.00RVU24A
2023-10-01$252.11$147.79RVU23D
2023-07-01$252.11$147.79RVU23C
2023-04-01$252.11$147.79RVU23B
2023-01-01$252.11$147.79RVU23A
2022-10-01$255.53$147.28RVU22D
2022-07-01$255.53$147.28RVU22C
2022-04-01$255.53$147.28RVU22B
2022-01-01$255.53$147.28RVU22A
2021-10-01$246.57$142.44RVU21D
2021-07-01$246.57$142.44RVU21C
2021-04-01$246.57$142.44RVU21B
2021-01-01$246.57$142.44RVU21A
2020-10-01$232.52$139.76RVU20D
2020-07-01$232.52$139.76RVU20C
2020-04-01$232.52$139.76RVU20B
2020-01-01$232.52$139.76RVU20A
2019-10-01$230.31$138.77RVU19D
2019-07-01$230.31$138.77RVU19C
2019-04-01$230.31$138.77RVU19B
2019-01-01$230.31$138.77RVU19A
2018-10-01$226.42$137.16RVU18D
2018-07-01$226.42$137.16RVU18C
2018-04-01$226.42$137.16RVU18B
2018-01-01$226.42$137.16RVU18AR1
2017-10-01$227.87$137.71RVU17D
2017-07-01$227.87$137.71RVU17C
2017-04-01$227.87$137.71RVU17B
2017-01-01$227.87$137.71RVU17A
2016-10-01$230.12$138.99RVU16D
2016-07-01$230.12$138.99RVU16C
2016-04-01$230.12$138.99RVU16B
2016-01-01$230.12$138.99RVU16A
2015-10-01$229.15$138.77RVU15D
2015-07-01$229.15$138.77RVU15C
2015-04-01$228.01$138.08RVU15B
2015-01-01$228.01$138.08RVU15A
2014-10-01$229.20$137.85RVU14D
2014-07-01$229.20$137.85RVU14C
2014-04-01$229.20$137.85RVU14B
2014-01-01$229.20$137.85RVU14A
2013-10-01$234.68$137.87RVU13D
2013-07-01$234.68$137.87RVU13C
2013-04-01$234.68$137.87RVU13B
2013-01-01$234.68$137.87RVU13AR

Price 42806 for an earlier date of service

Where the Houston, TX rate applies

Houston, TX is a Medicare payment area, not a city. Our Census mapping connects it to 46 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 Houston, TXGPCI2026.csv, line 102 (RVU26D)

Open CMS sourceHow we calculate rates

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