Billing code 42809: Foreign body removalMedicare rate & RVUs

Medicare pays $214.43 for 42809 nationally in the office and $116.90 in a hospital or facility. Local office rates run $189.51–$280.67.

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

What 42809 covers

An otolaryngologist commonly removes an object lodged in the pharynx by working through the mouth under direct visualization. A fish bone caught in the tonsillar area or posterior pharynx is a typical example. The procedure may be performed in an office or an operating room, depending on the object’s location, access, and the patient’s ability to tolerate removal. Document the object, its precise pharyngeal location, the approach, and the extraction performed.

Report this code for removal of a foreign object, not for sampling or excising pharyngeal tissue. CMS assigns a 10-day minor-procedure global period, so related postoperative visits during that period are included. When multiple procedures occur 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 not appropriate for this service. CMS does not pay an assistant at surgery for this code, and co-surgeons and team surgery 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 42809 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

42809 rates by state

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

How the 42809 rate is calculated

Each of 42809’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 42809

42809 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

42809 compared with similar codes

How to choose

42800Biopsy

42809 removes a foreign object from the pharynx. 42800 is for sampling pharyngeal tissue, not extracting an object.

42808Pharyngeal lesion treatment

Use 42809 for a foreign object; 42808 describes excision of a pharyngeal lesion.

31530Laryngoscopy

Choose 42809 when the object is in the pharynx and 31530 when it is in the larynx and removed by direct operative laryngoscopy.

43215Object removal

Use 42809 for an object lodged in the pharynx. Use 43215 when the object is in the esophagus and removed by flexible esophagoscopy.

Codes related to 42809

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