CPT code 42890: Pharyngectomy, limited resection2026 Medicare rate & RVUs in South Carolina

In South Carolina, Medicare pays $1,200.33 for 42890 in a facility. There’s no office rate.

Check a contract rate as a % of Medicare · 42890 nationwide

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

What 42890 covers

An otolaryngologist or head and neck surgeon removes a limited segment of pharyngeal tissue. The operation may treat a localized tumor or another lesion when the surgeon must resect pharyngeal tissue rather than perform a biopsy or remove only a superficial lesion. It is generally performed in an operating room, with the operative report describing the site and extent of tissue removed.

Report this code when the documented procedure is a limited pharyngectomy, not a diagnostic sampling or a more extensive pharyngeal resection. Documentation should identify the pharyngeal site, the tissue removed, and the reason a segmental resection was performed. Medicare assigns a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. 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. Assistant-at-surgery payment may be made; co-surgeon payment requires supporting documentation, and team surgery is 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 South Carolina compares for 42890

Across 109 of 109 payment localities, the facility rate for 42890 runs from $1,134.34 in Arkansas to $1,560.38 in Alaska. South Carolina pays $1,200.33. The RVUs are the same everywhere; the geographic indexes change the dollars.

Every other payment area

42890 rates by state

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

See 42890 in every payment locality

How the 42890 rate is calculated

Each of 42890’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 42890

42890 has a 90-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

Codes related to 42890

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

How 42890 has changed in South Carolina

Price 42890 for an earlier date of service

Where the South Carolina rate applies

South Carolina is a Medicare payment area, not a city. Our Census mapping connects it to 475 cities and communities in South Carolina. Some span more than one payment area; confirm with the service ZIP.

• Abbeville
• Abney Crossroads
• Adams Run
• Aiken
• Alcolu
• Allendale
• Anderson
• Andrews

Browse all communities in South Carolina

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