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CMS RVU26D · Effective 2026-10-01

42894 in Austin

Office / nonfacility

Not available in this setting

Base rate per service

Facility setting

$2103.07

Base rate per service

Amounts below use the non-QP conversion factor for participating physicians. These are base physician payments before claim-level adjustments, not patient costs or total hospital charges.

Otolaryngology surgery

About 42894: Pharyngeal wall resection with free flap

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

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.

CMS billing rules for 42894

Global period
Major surgery with a 90-day global period: the day-before preoperative visit and 90 days of related postoperative care are included.
Multiple procedures
Standard multiple procedure reduction: the highest-valued procedure is paid in full and others at 50% when performed in the same session.
Bilateral procedures
Bilateral adjustment does not apply; the descriptor or anatomy makes modifier 50 inappropriate.
Assistant at surgery
Assistant at surgery may be paid.
Co-surgeons
Co-surgeons paid only with supporting documentation.
Team surgery
Team surgery not permitted.

Where the value comes from

  • Work RVU33.07 · 53%
  • Practice expense (office) RVU24.14 · 39%
  • Malpractice RVU4.84 · 8%

238

Medicare services in 2024 · #4172 by national volume

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.

42894 compared with similar codes

Office rates for Austin, from the same CMS release.

42892

Pharyngeal repair

Wall revision

No office rate

Both involve pharyngeal wall resection, but 42894 is associated with free-flap closure; 42892 is used when closure is accomplished with a local flap.

42890

Pharyngectomy

Limited resection

No office rate

42890 describes limited pharyngeal resection. Use 42894 when the wall resection requires closure with a free flap.

42808

Pharyngeal lesion treatment

Excision or destruction

$241.78

42808 is for excision of a pharyngeal lesion; it does not describe the more extensive wall resection and free-flap reconstruction represented by 42894.

The same code, a different location

How does Austin compare?

42894 across payment areas

Same release and payment basis · bars start at $0

  1. Austin · This locality

    Unavailable

  2. Beaumont

    Unavailable

    No comparable rate is available in this setting.

  3. Brazoria

    Unavailable

    No comparable rate is available in this setting.

  4. Dallas

    Unavailable

    No comparable rate is available in this setting.

  5. Fort Worth

    Unavailable

    No comparable rate is available in this setting.

  6. Galveston

    Unavailable

    No comparable rate is available in this setting.

  7. Houston

    Unavailable

    No comparable rate is available in this setting.

Other payment areas listed in Texas appear first, followed by selected cross-country examples. The chart compares amounts, not distance.

The code’s RVUs stay the same in these comparisons. Geographic adjustments to work, practice expense and malpractice change the dollar amount. A city name alone may not identify the payment area for a service address.

Compare all 108 other payment areas
  • Rest Of Texas

    Texas · 42894

    Office

    Unavailable

    Facility

    $2015.72

    No comparable office rate is available.

  • Los Angeles-Long Beach-Anaheim (Los Angeles/Orange Cnty)

    California · 42894

    Office

    Unavailable

    Facility

    $2211.05

    No comparable office rate is available.

  • Dc + Md/Va Suburbs

    District of Columbia · 42894

    Office

    Unavailable

    Facility

    $2293.96

    No comparable office rate is available.

  • Miami

    Florida · 42894

    Office

    Unavailable

    Facility

    $2352.76

    No comparable office rate is available.

  • Chicago

    Illinois · 42894

    Office

    Unavailable

    Facility

    $2293.64

    No comparable office rate is available.

  • Manhattan

    New York · 42894

    Office

    Unavailable

    Facility

    $2368.57

    No comparable office rate is available.

  • Alaska*

    Alaska · 42894

    Office

    Unavailable

    Facility

    $2604.63

    No comparable office rate is available.

  • Alabama

    Alabama · 42894

    Office

    Unavailable

    Facility

    $1901.58

    No comparable office rate is available.

  • Arkansas

    Arkansas · 42894

    Office

    Unavailable

    Facility

    $1880.43

    No comparable office rate is available.

  • Arizona

    Arizona · 42894

    Office

    Unavailable

    Facility

    $2024.25

    No comparable office rate is available.

  • Bakersfield

    California · 42894

    Office

    Unavailable

    Facility

    $2107.71

    No comparable office rate is available.

  • Chico

    California · 42894

    Office

    Unavailable

    Facility

    $2093.70

    No comparable office rate is available.

  • El Centro

    California · 42894

    Office

    Unavailable

    Facility

    $2094.51

    No comparable office rate is available.

  • Fresno

    California · 42894

    Office

    Unavailable

    Facility

    $2093.70

    No comparable office rate is available.

  • Hanford-Corcoran

    California · 42894

    Office

    Unavailable

    Facility

    $2093.70

    No comparable office rate is available.

  • Madera

    California · 42894

    Office

    Unavailable

    Facility

    $2093.70

    No comparable office rate is available.

  • Merced

    California · 42894

    Office

    Unavailable

    Facility

    $2093.70

    No comparable office rate is available.

  • Modesto

    California · 42894

    Office

    Unavailable

    Facility

    $2093.70

    No comparable office rate is available.

  • Napa

    California · 42894

    Office

    Unavailable

    Facility

    $2318.98

    No comparable office rate is available.

  • Oxnard-Thousand Oaks-Ventura

    California · 42894

    Office

    Unavailable

    Facility

    $2189.25

    No comparable office rate is available.

  • Redding

    California · 42894

    Office

    Unavailable

    Facility

    $2093.70

    No comparable office rate is available.

  • Rest Of California

    California · 42894

    Office

    Unavailable

    Facility

    $2093.70

    No comparable office rate is available.

  • Riverside-San Bernardino-Ontario

    California · 42894

    Office

    Unavailable

    Facility

    $2146.05

    No comparable office rate is available.

  • Sacramento-Roseville-Folsom

    California · 42894

    Office

    Unavailable

    Facility

    $2168.71

    No comparable office rate is available.

  • Salinas

    California · 42894

    Office

    Unavailable

    Facility

    $2159.96

    No comparable office rate is available.

  • San Diego-Chula Vista-Carlsbad

    California · 42894

    Office

    Unavailable

    Facility

    $2189.66

    No comparable office rate is available.

  • San Francisco-Oakland-Berkeley (Marin Cnty)

    California · 42894

    Office

    Unavailable

    Facility

    $2420.58

    No comparable office rate is available.

  • San Francisco-Oakland-Berkeley (San Francisco/San Mateo/Alameda/Contra Costa Cnty)

    California · 42894

    Office

    Unavailable

    Facility

    $2415.09

    No comparable office rate is available.

  • San Jose-Sunnyvale-Santa Clara (San Benito Cnty)

    California · 42894

    Office

    Unavailable

    Facility

    $2475.40

    No comparable office rate is available.

  • San Jose-Sunnyvale-Santa Clara (Santa Clara Cnty)

    California · 42894

    Office

    Unavailable

    Facility

    $2452.93

    No comparable office rate is available.

  • San Luis Obispo-Paso Robles

    California · 42894

    Office

    Unavailable

    Facility

    $2128.37

    No comparable office rate is available.

  • Santa Cruz-Watsonville

    California · 42894

    Office

    Unavailable

    Facility

    $2194.07

    No comparable office rate is available.

  • Santa Maria-Santa Barbara

    California · 42894

    Office

    Unavailable

    Facility

    $2162.29

    No comparable office rate is available.

  • Santa Rosa-Petaluma

    California · 42894

    Office

    Unavailable

    Facility

    $2214.49

    No comparable office rate is available.

  • Stockton

    California · 42894

    Office

    Unavailable

    Facility

    $2093.70

    No comparable office rate is available.

  • Vallejo

    California · 42894

    Office

    Unavailable

    Facility

    $2311.06

    No comparable office rate is available.

  • Visalia

    California · 42894

    Office

    Unavailable

    Facility

    $2093.70

    No comparable office rate is available.

  • Yuba City

    California · 42894

    Office

    Unavailable

    Facility

    $2093.70

    No comparable office rate is available.

  • Colorado

    Colorado · 42894

    Office

    Unavailable

    Facility

    $2101.98

    No comparable office rate is available.

  • Connecticut

    Connecticut · 42894

    Office

    Unavailable

    Facility

    $2190.65

    No comparable office rate is available.

  • Delaware

    Delaware · 42894

    Office

    Unavailable

    Facility

    $2052.05

    No comparable office rate is available.

  • Fort Lauderdale

    Florida · 42894

    Office

    Unavailable

    Facility

    $2213.63

    No comparable office rate is available.

  • Rest Of Florida

    Florida · 42894

    Office

    Unavailable

    Facility

    $2118.36

    No comparable office rate is available.

  • Atlanta

    Georgia · 42894

    Office

    Unavailable

    Facility

    $2121.23

    No comparable office rate is available.

  • Rest Of Georgia

    Georgia · 42894

    Office

    Unavailable

    Facility

    $2016.48

    No comparable office rate is available.

  • Hawaii, Guam

    Hawaii · 42894

    Office

    Unavailable

    Facility

    $2114.93

    No comparable office rate is available.

  • Iowa

    Iowa · 42894

    Office

    Unavailable

    Facility

    $1906.51

    No comparable office rate is available.

  • Idaho

    Idaho · 42894

    Office

    Unavailable

    Facility

    $1922.83

    No comparable office rate is available.

  • East St. Louis

    Illinois · 42894

    Office

    Unavailable

    Facility

    $2171.95

    No comparable office rate is available.

  • Rest Of Illinois

    Illinois · 42894

    Office

    Unavailable

    Facility

    $2093.39

    No comparable office rate is available.

  • Suburban Chicago

    Illinois · 42894

    Office

    Unavailable

    Facility

    $2226.83

    No comparable office rate is available.

  • Indiana

    Indiana · 42894

    Office

    Unavailable

    Facility

    $1930.57

    No comparable office rate is available.

  • Kansas

    Kansas · 42894

    Office

    Unavailable

    Facility

    $1914.94

    No comparable office rate is available.

  • Kentucky

    Kentucky · 42894

    Office

    Unavailable

    Facility

    $1969.29

    No comparable office rate is available.

  • New Orleans

    Louisiana · 42894

    Office

    Unavailable

    Facility

    $2046.94

    No comparable office rate is available.

  • Rest Of Louisiana

    Louisiana · 42894

    Office

    Unavailable

    Facility

    $1973.01

    No comparable office rate is available.

  • Metropolitan Boston

    Massachusetts · 42894

    Office

    Unavailable

    Facility

    $2256.45

    No comparable office rate is available.

  • Rest Of Massachusetts

    Massachusetts · 42894

    Office

    Unavailable

    Facility

    $2100.12

    No comparable office rate is available.

  • Baltimore/Surr. Cntys

    Maryland · 42894

    Office

    Unavailable

    Facility

    $2187.37

    No comparable office rate is available.

  • Rest Of Maryland

    Maryland · 42894

    Office

    Unavailable

    Facility

    $2079.99

    No comparable office rate is available.

  • Rest Of Maine

    Maine · 42894

    Office

    Unavailable

    Facility

    $1946.91

    No comparable office rate is available.

  • Southern Maine

    Maine · 42894

    Office

    Unavailable

    Facility

    $2005.62

    No comparable office rate is available.

  • Detroit

    Michigan · 42894

    Office

    Unavailable

    Facility

    $2155.20

    No comparable office rate is available.

  • Rest Of Michigan

    Michigan · 42894

    Office

    Unavailable

    Facility

    $2023.23

    No comparable office rate is available.

  • Minnesota

    Minnesota · 42894

    Office

    Unavailable

    Facility

    $1982.10

    No comparable office rate is available.

  • Metropolitan Kansas City

    Missouri · 42894

    Office

    Unavailable

    Facility

    $2019.62

    No comparable office rate is available.

  • Metropolitan St. Louis

    Missouri · 42894

    Office

    Unavailable

    Facility

    $2034.15

    No comparable office rate is available.

  • Rest Of Missouri

    Missouri · 42894

    Office

    Unavailable

    Facility

    $1957.05

    No comparable office rate is available.

  • Mississippi

    Mississippi · 42894

    Office

    Unavailable

    Facility

    $1918.26

    No comparable office rate is available.

  • Montana**

    Montana · 42894

    Office

    Unavailable

    Facility

    $2072.20

    No comparable office rate is available.

  • North Carolina

    North Carolina · 42894

    Office

    Unavailable

    Facility

    $1960.14

    No comparable office rate is available.

  • North Dakota**

    North Dakota · 42894

    Office

    Unavailable

    Facility

    $1976.50

    No comparable office rate is available.

  • Nebraska

    Nebraska · 42894

    Office

    Unavailable

    Facility

    $1909.89

    No comparable office rate is available.

  • New Hampshire

    New Hampshire · 42894

    Office

    Unavailable

    Facility

    $2085.38

    No comparable office rate is available.

  • Northern Nj

    New Jersey · 42894

    Office

    Unavailable

    Facility

    $2282.11

    No comparable office rate is available.

  • Rest Of New Jersey

    New Jersey · 42894

    Office

    Unavailable

    Facility

    $2206.57

    No comparable office rate is available.

  • New Mexico

    New Mexico · 42894

    Office

    Unavailable

    Facility

    $2038.10

    No comparable office rate is available.

  • Nevada**

    Nevada · 42894

    Office

    Unavailable

    Facility

    $2046.33

    No comparable office rate is available.

  • Nyc Suburbs/Long Island

    New York · 42894

    Office

    Unavailable

    Facility

    $2434.15

    No comparable office rate is available.

  • Poughkpsie/N Nyc Suburbs

    New York · 42894

    Office

    Unavailable

    Facility

    $2232.78

    No comparable office rate is available.

  • Queens

    New York · 42894

    Office

    Unavailable

    Facility

    $2361.42

    No comparable office rate is available.

  • Rest Of New York

    New York · 42894

    Office

    Unavailable

    Facility

    $1984.20

    No comparable office rate is available.

  • Ohio

    Ohio · 42894

    Office

    Unavailable

    Facility

    $2003.67

    No comparable office rate is available.

  • Oklahoma

    Oklahoma · 42894

    Office

    Unavailable

    Facility

    $1950.20

    No comparable office rate is available.

  • Portland

    Oregon · 42894

    Office

    Unavailable

    Facility

    $2138.31

    No comparable office rate is available.

  • Rest Of Oregon

    Oregon · 42894

    Office

    Unavailable

    Facility

    $2021.29

    No comparable office rate is available.

  • Metropolitan Philadelphia

    Pennsylvania · 42894

    Office

    Unavailable

    Facility

    $2156.67

    No comparable office rate is available.

  • Rest Of Pennsylvania

    Pennsylvania · 42894

    Office

    Unavailable

    Facility

    $1997.52

    No comparable office rate is available.

  • Puerto Rico

    Puerto Rico · 42894

    Office

    Unavailable

    Facility

    $2078.97

    No comparable office rate is available.

  • Rhode Island

    Rhode Island · 42894

    Office

    Unavailable

    Facility

    $2102.66

    No comparable office rate is available.

  • South Carolina

    South Carolina · 42894

    Office

    Unavailable

    Facility

    $1987.00

    No comparable office rate is available.

  • South Dakota**

    South Dakota · 42894

    Office

    Unavailable

    Facility

    $1965.18

    No comparable office rate is available.

  • Tennessee

    Tennessee · 42894

    Office

    Unavailable

    Facility

    $1924.30

    No comparable office rate is available.

  • Utah

    Utah · 42894

    Office

    Unavailable

    Facility

    $2007.66

    No comparable office rate is available.

  • Virginia

    Virginia · 42894

    Office

    Unavailable

    Facility

    $2011.29

    No comparable office rate is available.

  • Virgin Islands

    United States Virgin Islands · 42894

    Office

    Unavailable

    Facility

    $2078.97

    No comparable office rate is available.

  • Vermont

    Vermont · 42894

    Office

    Unavailable

    Facility

    $1984.60

    No comparable office rate is available.

  • Rest Of Washington

    Washington · 42894

    Office

    Unavailable

    Facility

    $2090.98

    No comparable office rate is available.

  • Seattle (King Cnty)

    Washington · 42894

    Office

    Unavailable

    Facility

    $2281.20

    No comparable office rate is available.

  • Wisconsin

    Wisconsin · 42894

    Office

    Unavailable

    Facility

    $1926.79

    No comparable office rate is available.

  • West Virginia

    West Virginia · 42894

    Office

    Unavailable

    Facility

    $2036.58

    No comparable office rate is available.

  • Wyoming**

    Wyoming · 42894

    Office

    Unavailable

    Facility

    $2030.49

    No comparable office rate is available.

See how rates vary across the country

42894 · Office / nonfacility · Non-QP. Choose a state to explore its payment localities. A range means the amount varies within that state.

Explore a state

Local rates. Clear comparisons.

Hover or focus a tile to see its rate range. Select it to open the state’s fee schedule.

View all state and territory rates as a table
State / territoryRate 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

Explore 42894 on the national rate map →

Where does this rate apply?

Austin is a Medicare payment area. Our Census mapping connects it to 31 cities and communities in Texas, including the examples shown here.

Some communities span more than one payment area. Follow a city link to compare all of its mapped areas, or check the service-location ZIP above for an address-level starting point.

Use this rate

What is a percentage of Medicare worth?

Turn a percentage into dollars for 42894 in Austin. This uses the base rate on this page, so the locality and release stay consistent.

Reference amount per service

$2313.38

$2103.07 × 110% = $2313.38

A contract may specify another Medicare year or additional adjustments. This is percentage arithmetic on the displayed base rate, not a claim adjudication.

Working with a whole code list?

Compare an offer across your annual code mix, including an older Medicare schedule or flat per-code rates.

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How this local rate is calculated

Each RVU component is multiplied by its own geographic practice cost index (GPCI). The three adjusted components are added, then multiplied by the conversion factor. These are the inputs used for 42894 in Austin.

PPRRVU2026_Oct_nonQPP.csv

5,094

Code
42894
Physician work
33.07
Practice expense
24.14
Malpractice
4.84

GPCI2026.csv

96

Locality
Austin
Physician work
1.002
Practice expense
1.058
Malpractice
0.886
Facility calculation for 42894 in Austin
ComponentRVULocality factorAdjusted
Physician work33.07× 1.00233.1361
Practice expense24.14× 1.05825.5401
Malpractice4.84× 0.8864.2882
Total RVUs62.9645
Conversion factor× 33.4009

Facility rate, Austin$2103.07

Open 42894 in the RVU calculator →

Explore RVUs, geographic factors and the full formula

Facility

Facility calculation inputs
ComponentRVULocal GPCI
Work33.071.002
Practice expense24.141.058
Malpractice4.840.886

(33.07 × 1.002 + 24.14 × 1.058 + 4.84 × 0.886) × $33.4009 = $2103.07

The office and facility calculations use their respective practice-expense RVUs. The facility amount here is the physician fee, not a separate hospital or facility bill.

How this rate has changed

42894 · Office / nonfacility

Rate unavailable

Effective 2026-10-01

A rate is unavailable in one of these releases, so a change cannot be calculated.

Base rate by release · bars start at $0 · select a bar to compare

One bar per available release, ordered by effective date. Missing rates remain gaps. These comparisons hold the code, setting and locality identifiers constant; they do not isolate which policy or input caused a change.

What changed, release by release

Explore release dates and calculate this code in an earlier period →

Each row uses the accepted CMS release effective on that date and the same contractor and locality identifiers. Missing rates stay visible. Historical boundaries may differ; verify the service address for an older claim.

Inspect every release and its CMS source
Effective fromOffice / nonfacilityFacilityCMS release
2026-10-01Not available in this setting$2103.07RVU26D
2026-07-01Not available in this setting$2103.07RVU26C
2026-04-01Not available in this setting$2103.07RVU26B
2026-01-01Not available in this setting$2103.07RVU26A
2025-10-01Not available in this setting$2318.84RVU25D
2025-07-01Not available in this setting$2318.84RVU25C
2025-04-01Not available in this setting$2318.84RVU25B
2025-01-01Not available in this setting$2318.84RVU25A

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 indices and the applicable conversion factor. Unavailable or separately priced services are labeled rather than assigned a made-up amount.

Source: RVU26D. Effective 2026-10-01 through the day before 2027-01-01.

RVUs for 42894PPRRVU2026_Oct_nonQPP.csv, line 5,094 (RVU26D)
Geographic factors for AustinGPCI2026.csv, line 96 (RVU26D)