$167.36–$208.34
42809 removes a foreign object from the pharynx. 42800 is for sampling pharyngeal tissue, not extracting an object.
On this page
CMS RVU26D · Effective 2026-10-01
42809 Foreign body removal Medicare reimbursement rates in California
Report pharyngeal foreign body removal when a clinician extracts an object lodged in the throat, such as a fish bone, rather than removing tissue. Compare 42809 office and facility rates across CMS payment localities in California.
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.
What does Medicare pay for 42809 in California?
California has 29 payment localities in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the 29 payment areas shown below, using the same CMS release.
Office / nonfacility
$225.01–$280.67
29 of 29 localities have a supported rate.
Lowest: Chico
Highest: San Jose-Sunnyvale-Santa Clara (San Benito Cnty)
A spread of $55.66 per service.
Facility setting
$118.11–$140.03
29 of 29 localities have a supported rate.
Lowest: Chico
Highest: San Jose-Sunnyvale-Santa Clara (San Benito Cnty)
A spread of $21.92 per service.
These are locality ranges, not averages or address-specific quotes. A facility-setting amount covers the physician service; it does not include a hospital’s separate bill. Choose a locality below to inspect its calculation, compare other payment areas, or price a percentage of Medicare.
Where 42809 pays more and less in California
29 payment localities
$225.01 to $280.67
Otolaryngology
About 42809: Pharyngeal foreign body removal
Report pharyngeal foreign body removal when a clinician extracts an object lodged in the throat, such as a fish bone, rather than removing tissue.
An otolaryngologist commonly removes an object lodged in the pharynx by working through the mouth under direct visualization. A fish bone caught in the tonsillar area or posterior pharynx is a typical example. The procedure may be performed in an office or an operating room, depending on the object’s location, access, and the patient’s ability to tolerate removal. Document the object, its precise pharyngeal location, the approach, and the extraction performed.
Report this code for removal of a foreign object, not for sampling or excising pharyngeal tissue. CMS assigns a 10-day minor-procedure global period, so related postoperative visits during that period are included. When multiple procedures occur 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 not appropriate for this service. CMS does not pay an assistant at surgery for this code, and co-surgeons and team surgery are not permitted.
CMS billing rules for 42809
- Global period
- Minor procedure with a 10-day global period: related postoperative visits for 10 days 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
- Statutory restriction: assistant at surgery is not paid.
- Co-surgeons
- Co-surgeons not permitted.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU1.81 · 28%
- Practice expense (office) RVU4.33 · 67%
- Malpractice RVU0.28 · 4%
335
Medicare services in 2024 · #3904 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.
42809 compared with similar codes
Office rates for California, from the same CMS release.
$244.39–$302.13
Use 42809 for a foreign object; 42808 describes excision of a pharyngeal lesion.
No office rate
Choose 42809 when the object is in the pharynx and 31530 when it is in the larynx and removed by direct operative laryngoscopy.
$465.44–$592.22
Use 42809 for an object lodged in the pharynx. Use 43215 when the object is in the esophagus and removed by flexible esophagoscopy.
Compare 42809 by payment locality
Find the payment area for your service address, then open its rate page for calculation inputs, release history and the percentage-of-Medicare tool. A city may cross payment-area boundaries; the ZIP lookup above helps resolve the location.
29 of 29 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Bakersfield | Office $225.81 | Facility $118.92 |
| Chico | Office $225.01 | Facility $118.11 |
| El Centro | Office $225.05 | Facility $118.16 |
| Fresno | Office $225.01 | Facility $118.11 |
| Hanford-Corcoran | Office $225.01 | Facility $118.11 |
| Los Angeles-Long Beach-Anaheim (Los Angeles/Orange Cnty) | Office $240.24 | Facility $124.86 |
| Madera | Office $225.01 | Facility $118.11 |
| Merced | Office $225.01 | Facility $118.11 |
| Modesto | Office $225.01 | Facility $118.11 |
| Napa | Office $259.63 | Facility $131.09 |
| Oxnard-Thousand Oaks-Ventura | Office $238.92 | Facility $123.64 |
| Redding | Office $225.01 | Facility $118.11 |
| Rest Of California | Office $225.01 | Facility $118.11 |
| Riverside-San Bernardino-Ontario | Office $228.03 | Facility $121.14 |
| Sacramento-Roseville-Folsom | Office $235.84 | Facility $122.42 |
| Salinas | Office $234.96 | Facility $121.93 |
| San Diego-Chula Vista-Carlsbad | Office $240.31 | Facility $123.66 |
| San Francisco-Oakland-Berkeley (Marin Cnty) | Office $274.41 | Facility $136.90 |
| San Francisco-Oakland-Berkeley (San Francisco/San Mateo/Alameda/Contra Costa Cnty) | Office $274.10 | Facility $136.58 |
| San Jose-Sunnyvale-Santa Clara (San Benito Cnty) | Office $280.67 | Facility $140.03 |
| San Jose-Sunnyvale-Santa Clara (Santa Clara Cnty) | Office $279.37 | Facility $138.73 |
| San Luis Obispo-Paso Robles | Office $231.23 | Facility $120.14 |
| Santa Cruz-Watsonville | Office $242.46 | Facility $123.96 |
| Santa Maria-Santa Barbara | Office $235.79 | Facility $122.07 |
| Santa Rosa-Petaluma | Office $244.88 | Facility $125.12 |
| Stockton | Office $225.01 | Facility $118.11 |
| Vallejo | Office $259.17 | Facility $130.63 |
| Visalia | Office $225.01 | Facility $118.11 |
| Yuba City | Office $225.01 | Facility $118.11 |
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42809 billing questions
How is this different from pharyngeal biopsy or lesion excision?
Use 42809 when the target is a foreign object. Use a biopsy or lesion-excision code when the clinician removes tissue for diagnosis or treatment.
Does a fish bone in the throat support this code?
Yes, when the fish bone is lodged in the pharynx and the clinician removes it. Document the specific site and the extraction.
Should modifier 50 be added for objects on both sides?
No. CMS identifies bilateral adjustment as inappropriate for this code; do not report modifier 50.
How does the multiple-procedure reduction affect this service?
When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and the other procedures are subject to the standard 50% reduction.
Are assistant surgeons or co-surgeons payable?
CMS does not pay an assistant at surgery for this code. Co-surgeons and team surgery are not permitted.
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.
5,07242804,,Biopsy of upper nose/throat,A,,1.26,5.01,,1.94,,0.18,6.45,3.38,0,010,0.10,0.80,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,07342806,,Biopsy of upper nose/throat,A,,1.59,5.39,,2.04,,0.22,7.20,3.85,0,010,0.10,0.80,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,07442808,,Excise pharynx lesion,A,,2.29,4.38,,1.80,,0.35,7.02,4.44,0,010,0.10,0.80,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,07542809,,Remove pharynx foreign body,A,,1.81,4.33,,1.41,,0.28,6.42,3.50,0,010,0.10,0.80,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,0764280F,,Pcp prophylax rxd 3mon low %,I,,0.00,0.00,,0.00,,0.00,0.00,0.00,9,XXX,0.00,0.00,0.00,9,9,9,9,9,9,,33.4009,09,0,99,0.00,0.00,0.00
5,07742810,,Excision of neck cyst,A,,3.30,7.79,,3.95,,0.47,11.56,7.72,0,090,0.09,0.81,0.10,2,1,2,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,07842815,,Excision of neck cyst,A,,7.13,6.14,NA,6.14,,1.05,14.32,14.32,0,090,0.09,0.81,0.10,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00