Billing code 42890: PharyngectomyMedicare rate & RVUs in Alaska
Reports surgical removal of a limited portion of the pharynx, such as for a localized lesion requiring resection beyond a simple lesion excision.
CMS doesn’t publish an office rate for 42890 in Alaska.
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 9 sections
What 42890 covers
An otolaryngologist or head and neck surgeon removes a limited segment of pharyngeal tissue. The operation may treat a localized tumor or another lesion when the surgeon must resect pharyngeal tissue rather than perform a biopsy or remove only a superficial lesion. It is generally performed in an operating room, with the operative report describing the site and extent of tissue removed.
Report this code when the documented procedure is a limited pharyngectomy, not a diagnostic sampling or a more extensive pharyngeal resection. Documentation should identify the pharyngeal site, the tissue removed, and the reason a segmental resection was performed. Medicare 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 procedure is paid in full and other procedures are subject to the standard 50% multiple-procedure reduction. Modifier 50 is inappropriate. Assistant-at-surgery payment may be made; 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.
42890 in Alaska*
| Payment locality | Office | Facility |
|---|---|---|
| Alaska* | Unavailable | $1,560.38 |
How the 42890 rate is calculated
Each of 42890’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 · 42890
RVUs × geographic indexes × conversion factor
Work18.65
18.65 RVUs× 1.000 GPCI
Practice expense16.17
16.17 RVUs× 1.000 GPCI
Malpractice2.76
2.76 RVUs× 1.000 GPCI
Adjusted RVUs
37.5800
Conversion factor
$33.4009
Medicare rate
$1,255.21
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 42890
42890 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 42890
Pharyngectomy
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 090 | Major surgery: the day before, the day of, and 90 days after are included. |
| Multiple procedures | 2 | Standard reduction: highest-valued procedure at 100%, others at 50%. |
| Bilateral (modifier 50) | 0 | The 150% bilateral adjustment doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 2 | Paid. |
| Co-surgeons (62) | 1 | Permitted with supporting documentation. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
| Split (54/55/56) | 0.09/0.81/0.10 | Share of the payment for pre-op, the procedure itself, and post-op care. |
Global surgery period · 42890
Pharyngectomy
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.
Pre-op dayGlobal period
What modifiers do to the payment
Modifier 51 · payment effect
With and without the modifier
42890 without 51 · national facility
$1,255.21
Pharyngectomy
42890-51 · Second procedure: 50%
$627.61
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%).
42890 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 42808Pharyngeal lesion treatment
- 42808 describes excision of a pharyngeal lesion. Use 42890 when the surgeon removes a limited portion of the pharynx rather than excising only the lesion.
- 42892Pharyngeal repair
- 42892 describes radical or extensive pharyngectomy with resection of part of the esophagus, with or without laryngectomy. 42890 is for a limited pharyngeal resection.
- 42842Throat resection
- 42842 is for radical resection involving the tonsil, pillars, and/or soft palate. Select it when that specific operative site and procedure are documented, rather than a limited pharyngeal resection.
42890 billing questions
How does this differ from excision of a pharyngeal lesion?
Use 42890 when the surgeon removes a limited portion of the pharynx. A localized lesion removed without that degree of pharyngeal resection may be reported with 42808 instead.
When would a more extensive pharyngectomy code be considered?
Consider 42892 when the operative report supports a radical or extensive pharyngectomy involving resection of part of the esophagus, with or without laryngectomy. The documented extent, not the diagnosis alone, distinguishes the procedures.
Is modifier 50 appropriate for bilateral work?
No. CMS identifies bilateral adjustment as inappropriate for this code; do not use modifier 50.
What postoperative care is included?
The 90-day global period includes the day-before preoperative visit and related postoperative care during the 90 days after surgery.
Can an assistant or co-surgeon be reported?
Assistant-at-surgery payment may be made. Co-surgeon payment requires supporting documentation, and team surgery is not permitted.
How are other procedures performed in the same session paid?
The highest-valued procedure is paid in full, and other procedures are subject to the standard 50% multiple-procedure reduction.
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
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