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

Excision or destruction of a pharyngeal lesion is reported when an otolaryngologist removes or ablates the lesion rather than obtaining a diagnostic sample alone.

CMS RVU26DEffective Oct 1, 2026One payment locality601 Medicare services in 2024

In North Carolina, Medicare pays $220.45 for 42808 in the office and $140.05 when it’s performed in a hospital or facility.

$220.45Office (non-facility)
$140.05Hospital or facility
−6.0%vs the national office rate ($234.47)

Check a contract rate as a % of Medicare · 42808 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 42808 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in North Carolina
  2. What 42808 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 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.

How North Carolina compares for 42808

Across 109 of 109 payment localities, the office rate for 42808 runs from $208.18 in Arkansas to $302.13 in San Benito County, CA. North Carolina pays $220.45. The RVUs are the same everywhere; the geographic indexes change the dollars.

42808 in North Carolina vs other payment areas
  1. North Carolina · this page$220.45
  2. Los Angeles, CA · California$260.45+$40.00
  3. Washington, DC area · District of Columbia$265.97+$45.52
  4. Miami, FL · Florida$258.35+$37.90
  5. Chicago, IL · Illinois$250.88+$30.43
  6. Manhattan, NY · New York$269.92+$49.47
  7. Alaska · Alaska$276.98+$56.53

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

Every other payment area

42808 in every other Medicare payment locality
Payment localityOfficeFacility
AlabamaAlabama$211.11$135.71
ArkansasArkansas$208.18$134.15
ArizonaArizona$228.26$144.75
Bakersfield, CACalifornia$245.40$150.95
Chico, CACalifornia$244.39$149.95
El Centro, CACalifornia$244.45$150.01
Fresno, CACalifornia$244.39$149.95
Hanford, CACalifornia$244.39$149.95

42808 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.

$208.18

$276.98

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

View every state and territory as a table
42808 office rate range by state
State / territoryOffice rate rangeLocalities
AK$276.981
AL$211.111
AR$208.181
AZ$228.261
CA$244.39–$302.1329
CO$242.191
CT$249.721
DC$265.971
DE$231.921
FL$233.92–$258.353
GA$220.92–$239.392
GU$249.601
HI$249.601
IA$214.991
ID$216.611
IL$228.33–$250.884
IN$217.791
KS$214.631
KY$217.241
LA$217.16–$227.432
MA$241.08–$264.712
MD$236.04–$265.973
ME$218.35–$228.842
MI$223.25–$237.372
MN$230.491
MO$213.98–$227.483
MS$211.091
MT$234.451
NC$220.451
ND$227.531
NE$215.941
NH$239.011
NJ$252.13–$263.502
NM$224.681
NV$232.671
NY$223.69–$277.045
OH$221.841
OK$216.211
OR$230.42–$248.942
PA$221.84–$244.112
PR$235.911
RI$239.491
SC$221.601
SD$226.711
TN$215.751
TX$220.48–$241.788
UT$224.501
VA$228.55–$265.972
VI$235.911
VT$227.241
WA$240.43–$269.372
WI$220.241
WV$220.351
WY$231.431

See 42808 in every payment locality

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.

How the rate is built · 42808

RVUs × geographic indexes × conversion factor

Office or facility?

Work2.29

2.29 RVUs× 1.000 GPCI

Practice expense4.38

4.38 RVUs× 1.000 GPCI

Malpractice0.35

0.35 RVUs× 1.000 GPCI

Adjusted RVUs

7.0200

Conversion factor

$33.4009

Medicare rate

$234.47

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

5,074

Code
42808
Physician work
2.29
Practice expense
4.38
Malpractice
0.35

GPCI2026.csv

83

Locality
North Carolina
Physician work
1.000
Practice expense
0.933
Malpractice
0.639
Office calculation for 42808 in North Carolina
ComponentRVULocality factorAdjusted
Physician work2.29× 1.0002.2900
Practice expense4.38× 0.9334.0865
Malpractice0.35× 0.6390.2236
Total RVUs6.6002
Conversion factor× 33.4009

Office rate, North Carolina$220.45

Office: (2.29 × 1 + 4.38 × 0.933 + 0.35 × 0.639) × $33.4009 = $220.45

Facility: (2.29 × 1 + 1.8 × 0.933 + 0.35 × 0.639) × $33.4009 = $140.05

Open 42808 in the RVU calculator

Payment rules and modifiers for 42808

42808 has a 10-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 42808

Pharyngeal lesion treatment, excision or destruction

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 · 42808

Pharyngeal lesion treatment, excision or destruction

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

42808 without 51 · national office

$234.47

Pharyngeal lesion treatment, excision or destruction

42808-51 · Second procedure: 50%

$117.24

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 42808

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

Codes related to 42808
CodeHow it relatesOffice range, North Carolina
Used instead
42800Biopsy, pharynx tissue samplingDiagnostic biopsy of a throat lesion when sampling, rather than excision or destruction, is performed.$150.03
42804Nasopharyngeal biopsy, nasopharynxBiopsy code for a nasopharyngeal site when diagnostic sampling is performed.$202.05
42806Nasopharyngeal biopsy, directly visualized tissue samplingBiopsy code for a hypopharyngeal site when diagnostic sampling is performed.$225.77
42890Pharyngectomy, limited resectionConsider for a limited pharyngectomy rather than treatment of a discrete lesion.No office rate

How 42808 has changed in North Carolina

42808 · Office / nonfacility

$220.45

Effective 2026-10-01

The base rate is $7.21 higher than on 2025-10-01, moving from $213.24 to $220.45 (3.4%).

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

    $213.24changed to$220.45

    • Conversion factor 32.3465 changed to 33.4009
    • Work RVU 2.35 changed to 2.29
    • Practice expense RVU 4.33 changed to 4.38
    • Practice expense GPCI 0.926 changed to 0.933
    • Malpractice GPCI 0.665 changed to 0.639

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $219.84changed to$213.24

    • Conversion factor 33.2875 changed to 32.3465
    • Practice expense RVU 4.35 changed to 4.33
    • Malpractice RVU 0.34 changed to 0.35

    Held through RVU25B, RVU25C, RVU25D.

  3. March 9, 2024

    RVU24AR

    $216.25changed to$219.84

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $224.20changed to$216.25

    • Conversion factor 33.8872 changed to 32.7442
    • Practice expense RVU 4.33 changed to 4.35
    • Practice expense GPCI 0.927 changed to 0.926
    • Malpractice GPCI 0.742 changed to 0.665

  5. January 1, 2023

    RVU23A

    $226.52changed to$224.20

    • Conversion factor 34.6062 changed to 33.8872
    • Practice expense RVU 4.23 changed to 4.33
    • Malpractice RVU 0.33 changed to 0.34
    • Practice expense GPCI 0.928 changed to 0.927
    • Malpractice GPCI 0.819 changed to 0.742

    Held through RVU23B, RVU23C, RVU23D.

  6. January 1, 2022

    RVU22A

    $224.55changed to$226.52

    • Conversion factor 34.8931 changed to 34.6062
    • Practice expense RVU 4.12 changed to 4.23
    • Malpractice RVU 0.32 changed to 0.33

    Held through RVU22B, RVU22C, RVU22D.

  7. January 1, 2021

    RVU21A

    $223.11changed to$224.55

    • Conversion factor 36.0896 changed to 34.8931
    • Practice expense RVU 3.86 changed to 4.12
    • Practice expense GPCI 0.930 changed to 0.928
    • Malpractice GPCI 0.757 changed to 0.819

    Held through RVU21B, RVU21C, RVU21D.

  8. January 1, 2020

    RVU20A

    $221.71changed to$223.11

    • Conversion factor 36.0391 changed to 36.0896
    • Practice expense RVU 3.83 changed to 3.86
    • Malpractice RVU 0.34 changed to 0.32
    • Practice expense GPCI 0.931 changed to 0.930
    • Malpractice GPCI 0.695 changed to 0.757

    Held through RVU20B, RVU20C, RVU20D.

  9. January 1, 2019

    RVU19A

    $218.54changed to$221.71

    • Conversion factor 35.9996 changed to 36.0391
    • Practice expense RVU 3.75 changed to 3.83
    • Malpractice RVU 0.33 changed to 0.34

    Held through RVU19B, RVU19C, RVU19D.

  10. January 1, 2018

    RVU18AR1

    $221.24changed to$218.54

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 3.83 changed to 3.75
    • Malpractice RVU 0.34 changed to 0.33
    • Malpractice GPCI 0.732 changed to 0.695

    Held through RVU18B, RVU18C, RVU18D.

  11. January 1, 2017

    RVU17A

    $223.68changed to$221.24

    • Conversion factor 35.8043 changed to 35.8887
    • Practice expense RVU 3.91 changed to 3.83
    • Practice expense GPCI 0.930 changed to 0.931
    • Malpractice GPCI 0.768 changed to 0.732

    Held through RVU17B, RVU17C, RVU17D.

  12. January 1, 2016

    RVU16A

    $222.82changed to$223.68

    • Conversion factor 35.9335 changed to 35.8043
    • Practice expense RVU 3.86 changed to 3.91

    Held through RVU16B, RVU16C, RVU16D.

  13. July 1, 2015

    RVU15C

    $221.71changed to$222.82

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  14. January 1, 2015

    RVU15A

    $222.91changed to$221.71

    • Conversion factor 35.8228 changed to 35.7547
    • Practice expense RVU 3.94 changed to 3.86
    • Malpractice RVU 0.29 changed to 0.34
    • Practice expense GPCI 0.929 changed to 0.930
    • Malpractice GPCI 0.732 changed to 0.768

    Held through RVU15B.

  15. January 1, 2014

    RVU14A

    $224.87changed to$222.91

    • Conversion factor 34.0230 changed to 35.8228
    • Practice expense RVU 4.37 changed to 3.94
    • Malpractice RVU 0.30 changed to 0.29
    • Practice expense GPCI 0.927 changed to 0.929
    • Malpractice GPCI 0.695 changed to 0.732

    Held through RVU14B, RVU14C, RVU14D.

  16. January 1, 2013

    RVU13AR

    Earliest loaded release: $224.87

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$220.45$140.05RVU26D
2026-07-01$220.45$140.05RVU26C
2026-04-01$220.45$140.05RVU26B
2026-01-01$220.45$140.05RVU26A
2025-10-01$213.24$154.53RVU25D
2025-07-01$213.24$154.53RVU25C
2025-04-01$213.24$154.53RVU25B
2025-01-01$213.24$154.53RVU25A
2024-10-01$219.84$157.88RVU24D
2024-07-01$219.84$157.88RVU24C
2024-04-01$219.84$157.88RVU24B
2024-03-09$219.84$157.88RVU24AR
2024-01-01$216.25$155.30RVU24A
2023-10-01$224.20$160.75RVU23D
2023-07-01$224.20$160.75RVU23C
2023-04-01$224.20$160.75RVU23B
2023-01-01$224.20$160.75RVU23A
2022-10-01$226.52$161.65RVU22D
2022-07-01$226.52$161.65RVU22C
2022-04-01$226.52$161.65RVU22B
2022-01-01$226.52$161.65RVU22A
2021-10-01$224.55$159.14RVU21D
2021-07-01$224.55$159.14RVU21C
2021-04-01$224.55$159.14RVU21B
2021-01-01$224.55$159.14RVU21A
2020-10-01$223.11$160.34RVU20D
2020-07-01$223.11$160.34RVU20C
2020-04-01$223.11$160.34RVU20B
2020-01-01$223.11$160.34RVU20A
2019-10-01$221.71$159.64RVU19D
2019-07-01$221.71$159.64RVU19C
2019-04-01$221.71$159.64RVU19B
2019-01-01$221.71$159.64RVU19A
2018-10-01$218.54$157.88RVU18D
2018-07-01$218.54$157.88RVU18C
2018-04-01$218.54$157.88RVU18B
2018-01-01$218.54$157.88RVU18AR1
2017-10-01$221.24$159.76RVU17D
2017-07-01$221.24$159.76RVU17C
2017-04-01$221.24$159.76RVU17B
2017-01-01$221.24$159.76RVU17A
2016-10-01$223.68$161.42RVU16D
2016-07-01$223.68$161.42RVU16C
2016-04-01$223.68$161.42RVU16B
2016-01-01$223.68$161.42RVU16A
2015-10-01$222.82$161.33RVU15D
2015-07-01$222.82$161.33RVU15C
2015-04-01$221.71$160.53RVU15B
2015-01-01$221.71$160.53RVU15A
2014-10-01$222.91$160.34RVU14D
2014-07-01$222.91$160.34RVU14C
2014-04-01$222.91$160.34RVU14B
2014-01-01$222.91$160.34RVU14A
2013-10-01$224.87$158.64RVU13D
2013-07-01$224.87$158.64RVU13C
2013-04-01$224.87$158.64RVU13B
2013-01-01$224.87$158.64RVU13AR

Price 42808 for an earlier date of service

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

Browse all communities in North Carolina

42808 billing questions

When should this code be used instead of a pharyngeal biopsy code?

Use this code when the lesion is removed or destroyed as treatment. A biopsy code describes diagnostic tissue sampling rather than lesion treatment.

Can pathology be billed separately when tissue is removed?

The surgeon’s lesion treatment and the pathologist’s examination of submitted tissue are distinct services. This code describes the procedure, not the laboratory examination.

Does modifier 50 apply if lesions are treated on both sides?

No. The CMS bilateral adjustment does not apply, and modifier 50 is inappropriate for this code.

How are other procedures in the same session paid?

The highest-valued procedure is paid in full; other procedures in that session are subject to the standard 50% multiple-procedure reduction.

Are assistant surgeons or co-surgeons payable?

Medicare does not pay an assistant at surgery for this code. Co-surgeon and team-surgery billing are not permitted.

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 42808PPRRVU2026_Oct_nonQPP.csv, line 5,074 (RVU26D)
Geographic factors for North CarolinaGPCI2026.csv, line 83 (RVU26D)

Open CMS sourceHow we calculate rates

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