Billing code 42842: Throat resectionMedicare rate & RVUs

Medicare pays $910.84 for 42842 nationally in a facility.

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

What 42842 covers

An otolaryngologist or head and neck surgeon uses this code for an extensive resection involving the tonsil, tonsillar pillars, and/or pharyngeal walls, commonly to remove an oropharyngeal malignancy. It describes a substantially wider operation than taking a biopsy or removing a discrete, limited pharyngeal lesion. The operative report should identify the structures and extent of tissue removed and state that the resulting area was left without closure.

Report this code when the documented operation matches that extent and closure status; a limited lesion excision or a resection closed primarily or reconstructed points to a different code. Medicare assigns a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. When multiple procedures occur in the same session, the highest-valued is paid in full and other procedures are subject to the standard 50% reduction. Modifier 50 is inappropriate. Assistant-at-surgery payment requires documented medical necessity; 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 42842 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

42842 rates by state

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

How the 42842 rate is calculated

Each of 42842’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 42842

42842 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

42842 compared with similar codes

How to choose

42844Throat resection

Choose 42844 when the extensive resection is followed by closure; this code describes leaving the operative area without closure.

42845Throat resection

Choose 42845 when flap reconstruction is performed after the extensive resection. This code is for the resection without closure.

42808Pharyngeal lesion treatment

Code 42808 describes excision of a pharyngeal lesion. This code is for a wider resection involving tonsillar or pharyngeal structures.

42890Pharyngectomy

Code 42890 is for a limited pharyngectomy; this code describes more extensive resection involving the tonsil, tonsillar pillars, and/or pharyngeal walls.

Codes related to 42842

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