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Billing code 42894: Pharyngeal reconstructionMedicare rate & RVUs

Reports removal of pharyngeal wall tissue when the resulting defect requires reconstruction with a free flap, commonly during head and neck cancer surgery.

CMS RVU26DEffective Oct 1, 2026109 payment localities238 Medicare services in 2024

Medicare pays $2,072.53 for 42894 nationally in a facility.

Medicare rate · 42894

Pharyngeal reconstruction

Swap in your local Medicare rate.

Work RVUs
33.07
Total RVUs
62.05
Global days
090

National rate · 2026

$2,072.53

Facility setting, before claim adjustments.

See every locality for 42894 → · 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 42894 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 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.

Where 42894 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

42894 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$1,901.58
Alaska*Unavailable$2,604.63
ArizonaUnavailable$2,024.25
ArkansasUnavailable$1,880.43
AtlantaUnavailable$2,121.23
AustinUnavailable$2,103.07
BakersfieldUnavailable$2,107.71
Baltimore/Surr. CntysUnavailable$2,187.37
BeaumontUnavailable$1,988.48
BrazoriaUnavailable$2,038.54

42894 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
42894 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 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.

How the rate is built · 42894

RVUs × geographic indexes × conversion factor

Swap in your local Medicare rate.

Work 33.07Practice expense 24.14Malpractice 4.84

62.0500 adjusted RVUs×$33.4009 conversion factor=$2,072.53

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

Payment rules and modifiers for 42894

42894 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 42894

Pharyngeal reconstruction

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 · 42894

Pharyngeal reconstruction

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

42894 without 51 · national facility

$2,072.53

Pharyngeal reconstruction

42894-51 · Second procedure: 50%

$1,036.27

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

42894 compared with similar codes

Compare codes

42894 vs 42892 vs 42890 vs 42808: national Medicare rates

Swap in your local Medicare rate.

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

How to choose

42892Pharyngeal repair
Both involve pharyngeal wall resection, but 42894 is associated with free-flap closure; 42892 is used when closure is accomplished with a local flap.
42890Pharyngectomy
42890 describes limited pharyngeal resection. Use 42894 when the wall resection requires closure with a free flap.
42808Pharyngeal lesion treatment
42808 is for excision of a pharyngeal lesion; it does not describe the more extensive wall resection and free-flap reconstruction represented by 42894.

Codes related to 42894

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

Codes related to 42894
CodeHow it relatesNational office range
Same family
42892Pharyngeal repairRelated pharyngeal wall resection code for closure using a local flap.No office rate
Used instead
42890PharyngectomyLimited pharyngeal resection when the service does not require free-flap closure.No office rate
42808Pharyngeal lesion treatmentPharyngeal lesion excision for a more limited service than wall resection with free-flap reconstruction.$208.18–$302.13

42894 billing questions

How is this distinguished from 42892?

This code describes pharyngeal wall resection closed with a free flap. Code 42892 is the related option when closure uses a local flap.

Is this appropriate for a small pharyngeal lesion excision?

Not when the procedure is limited lesion excision without the pharyngeal wall resection and free-flap closure described here. Consider 42808 when that is the service performed.

What documentation supports reporting this code?

The operative report should establish the pharyngeal wall resection, the resulting defect, and closure using a free flap. A general statement that the pharynx was repaired is not enough to distinguish the service.

Can modifier 50 be appended for work on both sides?

No. CMS identifies bilateral adjustment as inappropriate for this code’s descriptor and anatomy.

How are assistant and co-surgeon services treated?

Assistant-at-surgery payment may be made. Co-surgeon payment requires supporting documentation; team surgery is not permitted.

What postoperative care is included?

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

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 42894PPRRVU2026_Oct_nonQPP.csv, line 5,094 (RVU26D)

Open CMS sourceHow we calculate rates

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