CPT code 42808: Pharyngeal lesion treatment, excision or destruction2026 Medicare rate & RVUs

Medicare pays $234.47 for 42808 nationally in the office and $148.30 in a hospital or facility. Local office rates run $208.18–$302.13.

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

What 42808 covers

An otolaryngologist reports this service for operative removal or destruction of a lesion in the pharynx, such as a mucosal growth on a pharyngeal wall. The procedure may be performed in an operating room or another procedure setting, using the approach suited to the lesion’s location and the surgeon’s method. Tissue may be submitted for pathology when excision produces a specimen; destruction may leave no specimen.

Choose this code when the service treats the lesion by removing or destroying it, not when the service is limited to diagnostic tissue sampling. Document the lesion’s pharyngeal location, the treatment performed, and the extent of removal or destruction; include pathology details when tissue is sent. Related postoperative visits during the 10-day global period are included. 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. Modifier 50 is inappropriate for this code. Medicare does not pay an assistant at surgery, 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 42808 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

42808 rates by state

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

How the 42808 rate is calculated

Each of 42808’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 42808

42808 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

42808 compared with similar codes

How to choose

42800BiopsyPharynx tissue sampling

42800 describes biopsy of a throat lesion for diagnosis. Use 42808 when the service removes or destroys the lesion rather than sampling it alone.

42804Nasopharyngeal biopsyNasopharynx

42804 is for biopsy at a nasopharyngeal site. 42808 describes lesion excision or destruction, not diagnostic sampling.

42806Nasopharyngeal biopsyDirectly visualized tissue sampling

42806 is for biopsy at a hypopharyngeal site. Choose 42808 when the service treats the lesion by excision or destruction.

42890PharyngectomyLimited resection

42890 describes a limited pharyngectomy, a more extensive pharyngeal resection. 42808 applies to excision or destruction of a lesion.

Codes related to 42808

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