CPT code 42892: Pharyngeal repair, wall revision2026 Medicare rate & RVUs in Arizona

Surgical revision of pharyngeal wall anatomy for selected structural deformities, including changes following earlier pharyngeal surgery or injury.

CMS RVU26DEffective Oct 1, 2026One payment locality99 Medicare services in 2024

In Arizona, Medicare pays $1,602.75 for 42892 in a facility. There’s no office rate.

Not available in this settingOffice (non-facility)

$1,602.75Hospital or facility

Check a contract rate as a % of Medicare · 42892 nationwide

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

On this page 11 sections

Rate in Arizona
What 42892 covers
Compared with other areas
Rate map
How it’s calculated
Payment rules
Related codes
Rate history
Where it applies
Billing questions
Sources

What 42892 covers

An otolaryngologist or head-and-neck surgeon uses this service to revise pharyngeal wall anatomy, such as a persistent deformity or narrowing after prior pharyngeal surgery or injury. The operation is performed in an operating room, generally in a hospital or ambulatory surgical setting. The operative report should identify the affected pharyngeal segment and describe the wall-revision work performed, rather than only a biopsy or removal of a discrete lesion.

Select the code from the documented operation, not from the symptom alone; record the anatomy, extent of revision, and reason for surgery. CMS 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 is paid in full and others at 50%. Modifier 50 is inappropriate. Assistant-at-surgery payment may be allowed; 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 Arizona compares for 42892

Across 109 of 109 payment localities, the facility rate for 42892 runs from $1,486.91 in Arkansas to $2,053.24 in Alaska. Arizona pays $1,602.75. The RVUs are the same everywhere; the geographic indexes change the dollars.

42892 in Arizona vs other payment areas

Arizona · this page$1,602.75
Los Angeles, CA · California$1,757.17+$154.42
Washington, DC area · District of Columbia$1,820.33+$217.58
Miami, FL · Florida$1,857.75+$255.00
Chicago, IL · Illinois$1,810.64+$207.89
Manhattan, NY · New York$1,876.54+$273.79
Alaska · Alaska$2,053.24+$450.49

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

Every other payment area

42892 in every other Medicare payment locality
Payment locality	Office	Facility
AlabamaAlabama	—	$1,503.93
ArkansasArkansas	—	$1,486.91
Bakersfield, CACalifornia	—	$1,673.43
Chico, CACalifornia	—	$1,662.71
El Centro, CACalifornia	—	$1,663.33
Fresno, CACalifornia	—	$1,662.71
Hanford, CACalifornia	—	$1,662.71
Madera, CACalifornia	—	$1,662.71
Merced, CACalifornia	—	$1,662.71
Modesto, CACalifornia	—	$1,662.71
Napa, CACalifornia	—	$1,846.99
Oxnard, CACalifornia	—	$1,740.41
Redding, CACalifornia	—	$1,662.71
Rest of CaliforniaCalifornia	—	$1,662.71
Riverside, CACalifornia	—	$1,702.73
Sacramento, CACalifornia	—	$1,723.71
Salinas, CACalifornia	—	$1,716.79
San Diego, CACalifornia	—	$1,741.47
Marin County, CACalifornia	—	$1,929.70
San Francisco, CACalifornia	—	$1,925.50
San Benito County, CACalifornia	—	$1,973.38
Santa Clara County, CACalifornia	—	$1,956.20
San Luis Obispo, CACalifornia	—	$1,691.52
Santa Cruz, CACalifornia	—	$1,745.83
Santa Maria, CACalifornia	—	$1,718.94
Santa Rosa, CACalifornia	—	$1,762.17
Stockton, CACalifornia	—	$1,662.71
Vallejo, CACalifornia	—	$1,840.93
Visalia, CACalifornia	—	$1,662.71
Yuba City, CACalifornia	—	$1,662.71
ColoradoColorado	—	$1,667.31
ConnecticutConnecticut	—	$1,735.82
DelawareDelaware	—	$1,625.04
Fort Lauderdale, FLFlorida	—	$1,749.89
Rest of FloridaFlorida	—	$1,674.00
Atlanta, GAGeorgia	—	$1,679.42
Rest of GeorgiaGeorgia	—	$1,592.69
Hawaii, Guam, HIHawaii	—	$1,681.08
IowaIowa	—	$1,509.85
IdahoIdaho	—	$1,522.59
East St. Louis, ILIllinois	—	$1,713.03
Rest of IllinoisIllinois	—	$1,652.61
Suburban Chicago, ILIllinois	—	$1,760.75
IndianaIndiana	—	$1,528.89
KansasKansas	—	$1,515.70
KentuckyKentucky	—	$1,556.44
New Orleans, LALouisiana	—	$1,618.60
Rest of LouisianaLouisiana	—	$1,559.08
Metropolitan Boston, MAMassachusetts	—	$1,792.47
Rest of MassachusettsMassachusetts	—	$1,665.31
Baltimore area, MDMaryland	—	$1,733.08
Rest of MarylandMaryland	—	$1,647.70
Rest of MaineMaine	—	$1,541.00
Southern Maine, MEMaine	—	$1,589.69
Detroit, MIMichigan	—	$1,702.65
Rest of MichiganMichigan	—	$1,598.97
MinnesotaMinnesota	—	$1,573.75
Metropolitan Kansas City, MOMissouri	—	$1,597.61
Metropolitan St. Louis, MOMissouri	—	$1,609.41
Rest of MissouriMissouri	—	$1,545.64
MississippiMississippi	—	$1,515.93
MontanaMontana	—	$1,641.07
North CarolinaNorth Carolina	—	$1,551.82
North DakotaNorth Dakota	—	$1,567.91
NebraskaNebraska	—	$1,512.86
New HampshireNew Hampshire	—	$1,653.34
Northern New JerseyNew Jersey	—	$1,810.33
Rest of New JerseyNew Jersey	—	$1,748.86
New MexicoNew Mexico	—	$1,610.55
NevadaNevada	—	$1,621.35
NYC suburbs and Long Island, NYNew York	—	$1,928.12
Poughkeepsie and northern NYC suburbs, NYNew York	—	$1,769.07
Queens, NYNew York	—	$1,872.14
Rest of New YorkNew York	—	$1,571.11
OhioOhio	—	$1,584.02
OklahomaOklahoma	—	$1,542.07
Portland, OROregon	—	$1,697.62
Rest of OregonOregon	—	$1,601.94
Metropolitan Philadelphia, PAPennsylvania	—	$1,707.90
Rest of PennsylvaniaPennsylvania	—	$1,579.58
Puerto RicoPuerto Rico	—	$1,646.84
Rhode IslandRhode Island	—	$1,666.19
South CarolinaSouth Carolina	—	$1,571.86
South DakotaSouth Dakota	—	$1,559.26
TennesseeTennessee	—	$1,523.13
Austin, TXTexas	—	$1,667.79
Beaumont, TXTexas	—	$1,572.24
Brazoria, TXTexas	—	$1,614.88
Dallas, TXTexas	—	$1,628.72
Fort Worth, TXTexas	—	$1,623.63
Galveston, TXTexas	—	$1,622.16
Houston, TXTexas	—	$1,689.88
Rest of TexasTexas	—	$1,595.16
UtahUtah	—	$1,588.51
VirginiaVirginia	—	$1,593.60
Virgin Islands, VIUnited States Virgin Islands	—	$1,646.84
VermontVermont	—	$1,573.57
Rest of WashingtonWashington	—	$1,658.32
King County, WAWashington	—	$1,813.19
WisconsinWisconsin	—	$1,527.66
West VirginiaWest Virginia	—	$1,606.81
WyomingWyoming	—	$1,609.19

42892 rates by state

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

ME WI VT NH MT ND MN MI NY MA RI WA ID WY SD IA IL IN OH PA NJ CT OR NV UT CO NE MO KY WV VA MD DE CA AZ NM KS OK AR TN NC SC DC TX LA MS AL GA FL AK HI

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Local rates. Clear comparisons.

Hover or focus a tile to see its rate range. Select it to open the state’s fee schedule.

View every state and territory as a table

42892 office rate range by state
State / territory	Office rate range	Localities
AK	No published base rate	1
AL	No published base rate	1
AR	No published base rate	1
AZ	No published base rate	1
CA	No published base rate	29
CO	No published base rate	1
CT	No published base rate	1
DC	No published base rate	1
DE	No published base rate	1
FL	No published base rate	3
GA	No published base rate	2
GU	No published base rate	1
HI	No published base rate	1
IA	No published base rate	1
ID	No published base rate	1
IL	No published base rate	4
IN	No published base rate	1
KS	No published base rate	1
KY	No published base rate	1
LA	No published base rate	2
MA	No published base rate	2
MD	No published base rate	3
ME	No published base rate	2
MI	No published base rate	2
MN	No published base rate	1
MO	No published base rate	3
MS	No published base rate	1
MT	No published base rate	1
NC	No published base rate	1
ND	No published base rate	1
NE	No published base rate	1
NH	No published base rate	1
NJ	No published base rate	2
NM	No published base rate	1
NV	No published base rate	1
NY	No published base rate	5
OH	No published base rate	1
OK	No published base rate	1
OR	No published base rate	2
PA	No published base rate	2
PR	No published base rate	1
RI	No published base rate	1
SC	No published base rate	1
SD	No published base rate	1
TN	No published base rate	1
TX	No published base rate	8
UT	No published base rate	1
VA	No published base rate	2
VI	No published base rate	1
VT	No published base rate	1
WA	No published base rate	2
WI	No published base rate	1
WV	No published base rate	1
WY	No published base rate	1

See 42892 in every payment locality

How the 42892 rate is calculated

Each of 42892’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 · 42892

RVUs × geographic indexes × conversion factor

Office or facility?

Your ZIP

Work25.38

25.38 RVUs× 1.000 GPCI

Practice expense20.06

20.06 RVUs× 1.000 GPCI

Malpractice3.70

3.70 RVUs× 1.000 GPCI

Adjusted RVUs

49.1400

Conversion factor

$33.4009

Medicare rate

$1,641.32

Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.

The exact Arizona inputs and CMS source lines

PPRRVU2026_Oct_nonQPP.csv

5,093

Code: 42892
Physician work: 25.38
Practice expense: 20.06
Malpractice: 3.70

GPCI2026.csv

Locality: Arizona
Physician work: 1.000
Practice expense: 0.969
Malpractice: 0.856

Facility calculation for 42892 in Arizona
Component	RVU	Locality factor	Adjusted
Physician work	25.38	× 1.000	25.3800
Practice expense	20.06	× 0.969	19.4381
Malpractice	3.70	× 0.856	3.1672
Total RVUs			47.9853
Conversion factor			× 33.4009

Facility rate, Arizona$1602.75

Facility: (25.38 × 1 + 20.06 × 0.969 + 3.7 × 0.856) × $33.4009 = $1602.75

Open 42892 in the RVU calculator

Payment rules and modifiers for 42892

42892 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 42892

Pharyngeal repair, wall revision

Rule	CMS value	What it means
Global period	090	Major surgery: the day before, the day of, and 90 days after are included.
Multiple procedures	2	Standard reduction: highest-valued procedure at 100%, others at 50%.
Bilateral (modifier 50)	0	The 150% bilateral adjustment doesn’t apply.
Assistant at surgery (80/81/82/AS)	2	Paid.
Co-surgeons (62)	1	Permitted with supporting documentation.
Team surgery (66)	0	Not permitted.
Professional/technical	0	Physician service: no professional/technical split.
Split (54/55/56)	0.09/0.81/0.10	Share of the payment for pre-op, the procedure itself, and post-op care.

Global surgery period · 42892

Pharyngeal repair, wall revision

Date of surgery

Date of a later visit

90-day global period ends

Dec 30, 2026

Covers Sep 30, 2026 through Dec 30, 2026 (92 days, including the day before surgery).

Visit on Oct 31, 2026

Day 30 of the 90-day post-op period: related follow-up care is included in the surgical payment.

24Unrelated E/M visit by the same physician
79Unrelated procedure (starts its own global period)
58Staged, more extensive, or therapy procedure that was planned
78Unplanned return to the operating room for a related complication

SurgeryVisit

Sep 23, 2026Jan 10, 2027

Pre-op dayGlobal period

What modifiers do to the payment

Modifier 51 · payment effect

With and without the modifier

42892 without 51 · national facility

$1,641.32

Pharyngeal repair, wall revision

42892-51 · Second procedure: 50%

$820.66

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 42892

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

Codes related to 42892
Code	How it relates	Office range, Arizona
Same family
42894	Pharyngeal reconstruction, free flap closureClosely related pharyngeal-wall revision code; select based on the documented operative work and full descriptor.	No office rate
Used instead
42890	Pharyngectomy, limited resectionLimited pharyngeal tissue removal, rather than revision of pharyngeal wall anatomy.	No office rate
42808	Pharyngeal lesion treatment, excision or destructionUsed for excision of a pharyngeal lesion rather than structural wall revision.	$228.26

How 42892 has changed in Arizona

42892 · Office / nonfacility

Rate unavailable

Effective 2026-10-01

Compare with release effective

A rate is unavailable in one of these releases, so a change cannot be calculated.

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

Rates in every CMS release
Effective from	Office	Facility	CMS release
2026-10-01	Not available in this setting	$1,602.75	RVU26D
2026-07-01	Not available in this setting	$1,602.75	RVU26C
2026-04-01	Not available in this setting	$1,602.75	RVU26B
2026-01-01	Not available in this setting	$1,602.75	RVU26A
2025-10-01	Not available in this setting	$1,762.68	RVU25D
2025-07-01	Not available in this setting	$1,762.68	RVU25C
2025-04-01	Not available in this setting	$1,762.68	RVU25B
2025-01-01	Not available in this setting	$1,762.68	RVU25A
2024-10-01	Not available in this setting	$1,815.42	RVU24D
2024-07-01	Not available in this setting	$1,815.42	RVU24C
2024-04-01	Not available in this setting	$1,815.42	RVU24B
2024-03-09	Not available in this setting	$1,815.42	RVU24AR
2024-01-01	Not available in this setting	$1,785.79	RVU24A
2023-10-01	Not available in this setting	$1,841.34	RVU23D
2023-07-01	Not available in this setting	$1,841.34	RVU23C
2023-04-01	Not available in this setting	$1,841.34	RVU23B
2023-01-01	Not available in this setting	$1,841.34	RVU23A
2022-10-01	Not available in this setting	$1,863.61	RVU22D
2022-07-01	Not available in this setting	$1,863.61	RVU22C
2022-04-01	Not available in this setting	$1,863.61	RVU22B
2022-01-01	Not available in this setting	$1,863.61	RVU22A
2021-10-01	Not available in this setting	$1,856.85	RVU21D
2021-07-01	Not available in this setting	$1,856.85	RVU21C
2021-04-01	Not available in this setting	$1,856.85	RVU21B
2021-01-01	Not available in this setting	$1,856.85	RVU21A
2020-10-01	Not available in this setting	$1,880.91	RVU20D
2020-07-01	Not available in this setting	$1,880.91	RVU20C
2020-04-01	Not available in this setting	$1,880.91	RVU20B
2020-01-01	Not available in this setting	$1,880.91	RVU20A
2019-10-01	Not available in this setting	$1,905.42	RVU19D
2019-07-01	Not available in this setting	$1,905.42	RVU19C
2019-04-01	Not available in this setting	$1,904.21	RVU19B
2019-01-01	Not available in this setting	$1,904.21	RVU19A
2018-10-01	Not available in this setting	$1,904.62	RVU18D
2018-07-01	Not available in this setting	$1,904.62	RVU18C
2018-04-01	Not available in this setting	$1,904.62	RVU18B
2018-01-01	Not available in this setting	$1,904.62	RVU18AR1
2017-10-01	Not available in this setting	$1,946.86	RVU17D
2017-07-01	Not available in this setting	$1,946.86	RVU17C
2017-04-01	Not available in this setting	$1,946.86	RVU17B
2017-01-01	Not available in this setting	$1,946.86	RVU17A
2016-10-01	Not available in this setting	$1,979.85	RVU16D
2016-07-01	Not available in this setting	$1,979.85	RVU16C
2016-04-01	Not available in this setting	$1,979.85	RVU16B
2016-01-01	Not available in this setting	$1,979.85	RVU16A
2015-10-01	Not available in this setting	$1,935.38	RVU15D
2015-07-01	Not available in this setting	$1,935.38	RVU15C
2015-04-01	Not available in this setting	$1,925.75	RVU15B
2015-01-01	Not available in this setting	$1,925.75	RVU15A
2014-10-01	Not available in this setting	$1,928.65	RVU14D
2014-07-01	Not available in this setting	$1,928.65	RVU14C
2014-04-01	Not available in this setting	$1,928.65	RVU14B
2014-01-01	Not available in this setting	$1,928.65	RVU14A
2013-10-01	Not available in this setting	$1,912.12	RVU13D
2013-07-01	Not available in this setting	$1,912.12	RVU13C
2013-04-01	Not available in this setting	$1,912.12	RVU13B
2013-01-01	Not available in this setting	$1,912.12	RVU13AR

Price 42892 for an earlier date of service

Where the Arizona rate applies

Arizona is a Medicare payment area, not a city. Our Census mapping connects it to 467 cities and communities in Arizona. Some span more than one payment area; confirm with the service ZIP.

Aguila
Ajo
Ak Chin
Ak-Chin Village
Alamo Lake
Ali Chuk
Ali Chukson
Ali Molina

Browse all communities in Arizona

42892 billing questions

How is 42892 distinguished from 42894?

Both concern pharyngeal-wall revision. Compare the operative details with each code's full descriptor and document the specific work performed; the short descriptors alone do not establish which code fits.

When is 42892 preferable to 42808?

42892 describes revision of pharyngeal wall anatomy. Code 42808 is for excision of a pharyngeal lesion, so a focal lesion removal alone does not support 42892.

What should the operative report document?

Identify the pharyngeal segment involved, the structural problem, and the revision performed. Include enough detail to distinguish wall revision from lesion excision or pharyngeal tissue removal.

Can modifier 50 be reported?

No. CMS identifies bilateral adjustment as inappropriate for this code, so modifier 50 should not be used.

How does the 90-day global period affect follow-up billing?

The day-before preoperative visit and 90 days of related postoperative care are included in the global period.

How are other same-session procedures paid?

Under the standard multiple procedure reduction, CMS pays the highest-valued procedure in full and other procedures at 50% when performed in the same session.

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 42892PPRRVU2026_Oct_nonQPP.csv, line 5,093 (RVU26D)

5,09042860,,[CPT descriptor omitted],A,,2.24,2.80,NA,2.80,,0.34,5.38,5.38,0,090,0.09,0.81,0.10,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00

5,09142870,,[CPT descriptor omitted],A,,5.38,10.25,NA,10.25,,0.79,16.42,16.42,0,090,0.09,0.81,0.10,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00

5,09242890,,[CPT descriptor omitted],A,,18.65,16.17,NA,16.17,,2.76,37.58,37.58,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00

5,09342892,,[CPT descriptor omitted],A,,25.38,20.06,NA,20.06,,3.70,49.14,49.14,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00

5,09442894,,[CPT descriptor omitted],A,,33.07,24.14,NA,24.14,,4.84,62.05,62.05,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00

5,09542900,,[CPT descriptor omitted],A,,5.16,2.73,NA,2.73,,0.76,8.65,8.65,0,010,0.10,0.80,0.10,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00

5,0964290F,,[CPT descriptor omitted],I,,0.00,0.00,,0.00,,0.00,0.00,0.00,9,XXX,0.00,0.00,0.00,9,9,9,9,9,9,,33.4009,09,0,99,0.00,0.00,0.00

Geographic factors for ArizonaGPCI2026.csv, line 6 (RVU26D)

3Medicare Administrative Contractor (MAC),State,Locality Number,Locality Name,2026 PW GPCI (with 1.0 Floor)***,2026 PE GPCI,2026 MP GPCI

410112,AL,00,ALABAMA,1.000,0.875,0.566

502102,AK,01,ALASKA*,1.500,1.065,0.551

603102,AZ,00,ARIZONA,1.000,0.969,0.856

707102,AR,13,ARKANSAS,1.000,0.859,0.515

801112,CA,54,BAKERSFIELD,1.019,1.096,0.609

901112,CA,55,CHICO,1.017,1.096,0.536

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What 42892 covers

How Arizona compares for 42892

Every other payment area

42892 rates by state

How the 42892 rate is calculated

Payment rules and modifiers for 42892

What modifiers do to the payment

Codes related to 42892

How 42892 has changed in Arizona

Where the Arizona rate applies

42892 billing questions

How is 42892 distinguished from 42894?

When is 42892 preferable to 42808?

What should the operative report document?

Can modifier 50 be reported?

How does the 90-day global period affect follow-up billing?

How are other same-session procedures paid?

Where these rates come from

Did this answer your question about what 42892 pays in Arizona?

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