CPT code 42894: Pharyngeal reconstruction, free flap closure2026 Medicare rate & RVUs in Puerto Rico

In Puerto Rico, Medicare pays $2,078.97 for 42894 in a facility. There’s no office rate.

Check a contract rate as a % of Medicare · 42894 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 42894 covers

An otolaryngologist or head and neck surgeon reports this service when resection of the pharyngeal wall leaves a defect that is closed using transferred tissue with its blood supply reconnected at the recipient site. It is most often part of complex operative treatment for a pharyngeal tumor, with reconstruction planned to restore continuity and support swallowing. A reconstructive surgeon may participate in the flap portion of the operation. These procedures are generally performed in a hospital operating room.

Select this code when the operative report supports both pharyngeal wall resection and closure with a free flap; a limited excision or closure with a local flap points to a different code. Documentation should identify the wall resected, the defect, and the free-flap reconstruction. CMS assigns a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. In a same-session multiple-procedure claim, the highest-valued procedure is paid in full and other procedures at 50%. Modifier 50 is inappropriate. Assistant-at-surgery payment may be available; 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 Puerto Rico compares for 42894

Across 109 of 109 payment localities, the facility rate for 42894 runs from $1,880.43 in Arkansas to $2,604.63 in Alaska. Puerto Rico pays $2,078.97. The RVUs are the same everywhere; the geographic indexes change the dollars.

Every other payment area

42894 rates by state

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

See 42894 in every payment locality

How the 42894 rate is calculated

Each of 42894’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 42894

42894 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 42894

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

How 42894 has changed in Puerto Rico

Price 42894 for an earlier date of service

Where the Puerto Rico rate applies

Puerto Rico is a Medicare payment area, not a city. Our Census mapping connects it to 292 cities and communities in Puerto Rico. Some span more than one payment area; confirm with the service ZIP.

• Aceitunas
• Adjuntas
• Aguada
• Aguadilla
• Aguas Buenas
• Aguas Claras
• Aguilita
• Aibonito

Browse all communities in Puerto Rico

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