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Billing code 42892: Pharyngeal repairMedicare rate & RVUs

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

CMS RVU26DEffective Oct 1, 2026109 payment localities99 Medicare services in 2024

Medicare pays $1,641.32 for 42892 nationally in a facility.

Medicare rate · 42892

Pharyngeal repair

Swap in your local Medicare rate.

Work RVUs
25.38
Total RVUs
49.14
Global days
090

National rate · 2026

$1,641.32

Facility setting, before claim adjustments.

See every locality for 42892 → · Billed by an NP, PA or therapist? →

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 10 sections
  1. Medicare rate
  2. What 42892 covers
  3. By payment locality
  4. Rate map
  5. How it’s calculated
  6. Payment rules
  7. Similar codes
  8. Related codes
  9. Billing questions
  10. 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.

Where 42892 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

42892 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$1,503.93
Alaska*Unavailable$2,053.24
ArizonaUnavailable$1,602.75
ArkansasUnavailable$1,486.91
AtlantaUnavailable$1,679.42
AustinUnavailable$1,667.79
BakersfieldUnavailable$1,673.43
Baltimore/Surr. CntysUnavailable$1,733.08
BeaumontUnavailable$1,572.24
BrazoriaUnavailable$1,614.88

42892 rates by state

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

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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 / territoryOffice rate rangeLocalities
AKNo published base rate1
ALNo published base rate1
ARNo published base rate1
AZNo published base rate1
CANo published base rate29
CONo published base rate1
CTNo published base rate1
DCNo published base rate1
DENo published base rate1
FLNo published base rate3
GANo published base rate2
GUNo published base rate1
HINo published base rate1
IANo published base rate1
IDNo published base rate1
ILNo published base rate4
INNo published base rate1
KSNo published base rate1
KYNo published base rate1
LANo published base rate2
MANo published base rate2
MDNo published base rate3
MENo published base rate2
MINo published base rate2
MNNo published base rate1
MONo published base rate3
MSNo published base rate1
MTNo published base rate1
NCNo published base rate1
NDNo published base rate1
NENo published base rate1
NHNo published base rate1
NJNo published base rate2
NMNo published base rate1
NVNo published base rate1
NYNo published base rate5
OHNo published base rate1
OKNo published base rate1
ORNo published base rate2
PANo published base rate2
PRNo published base rate1
RINo published base rate1
SCNo published base rate1
SDNo published base rate1
TNNo published base rate1
TXNo published base rate8
UTNo published base rate1
VANo published base rate2
VINo published base rate1
VTNo published base rate1
WANo published base rate2
WINo published base rate1
WVNo published base rate1
WYNo published base rate1

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

Swap in your local Medicare rate.

Work 25.38Practice expense 20.06Malpractice 3.70

49.1400 adjusted RVUs×$33.4009 conversion factor=$1,641.32

All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.

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

RuleCMS valueWhat it means
Global period090Major surgery: the day before, the day of, and 90 days after are included.
Multiple procedures2Standard reduction: highest-valued procedure at 100%, others at 50%.
Bilateral (modifier 50)0The 150% bilateral adjustment doesn’t apply.
Assistant at surgery (80/81/82/AS)2Paid.
Co-surgeons (62)1Permitted with supporting documentation.
Team surgery (66)0Not permitted.
Professional/technical0Physician service: no professional/technical split.
Split (54/55/56)0.09/0.81/0.10Share of the payment for pre-op, the procedure itself, and post-op care.

Global surgery period · 42892

Pharyngeal repair

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.

  • 24 Unrelated E/M visit by the same physician
  • 79 Unrelated procedure (starts its own global period)
  • 58 Staged, more extensive, or therapy procedure that was planned
  • 78 Unplanned 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

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

42892 compared with similar codes

Compare codes

42892 vs 42894 vs 42890 vs 42808: national Medicare rates

Swap in your local Medicare rate.

  • 42892
    Pharyngeal repair · 25.38 wRVU
    —
  • 42894
    Pharyngeal reconstruction · 33.07 wRVU
    —
  • 42890
    Pharyngectomy · 18.65 wRVU
    —
  • 42808
    Pharyngeal lesion treatment · 2.29 wRVU
    $234.47

How to choose

42894Pharyngeal reconstruction
This is the closest related pharyngeal-wall code. Use the complete code descriptors and operative report to distinguish the specific revision performed.
42890Pharyngectomy
42890 describes limited removal of pharyngeal tissue; 42892 is for revising pharyngeal wall anatomy.
42808Pharyngeal lesion treatment
42808 is for excising a pharyngeal lesion. Choose 42892 when the documented procedure revises the wall rather than simply removing a focal lesion.

Codes related to 42892

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

Codes related to 42892
CodeHow it relatesNational office range
Same family
42894Pharyngeal reconstructionClosely related pharyngeal-wall revision code; select based on the documented operative work and full descriptor.No office rate
Used instead
42890PharyngectomyLimited pharyngeal tissue removal, rather than revision of pharyngeal wall anatomy.No office rate
42808Pharyngeal lesion treatmentUsed for excision of a pharyngeal lesion rather than structural wall revision.$208.18–$302.13

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)

Open CMS sourceHow we calculate rates

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