No office rate
42842 describes the related radical resection without closure. Use 42845 when the resection requires closure with a free skin graft.
On this page
CMS RVU26D · Effective 2026-10-01
42845 Throat resection Medicare reimbursement rates in California
Reports radical removal of tonsillar or related oropharyngeal tissue when the resulting defect requires closure with a free skin graft. Compare 42845 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 42845 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
No supported rate
Facility setting
$1944.61–$2290.43
29 of 29 localities have a supported rate.
Lowest: Chico
Highest: San Jose-Sunnyvale-Santa Clara (San Benito Cnty)
A spread of $345.82 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 42845 pays more and less in California
Head and neck surgery
About 42845: Radical oropharyngeal resection with graft closure
Reports radical removal of tonsillar or related oropharyngeal tissue when the resulting defect requires closure with a free skin graft.
An otolaryngologist or head-and-neck surgeon may report this extensive operation for disease involving the tonsil, tonsillar pillars, or retromolar trigone. The surgeon removes the involved tissue and closes the resulting defect using a free skin graft. It is typically performed in an operating room, often for an extensive oropharyngeal tumor that cannot be managed with a limited lesion excision. The operative report should identify the resected structures and describe the graft closure.
Choose this code when the documented resection and closure meet this extensive procedure level; a smaller excision or a resection closed without a free skin graft belongs to a different code. Medicare includes the day-before preoperative visit and 90 days of related postoperative care in the 90-day global period. 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% reduction. Modifier 50 is inappropriate for this code. An assistant at surgery may be paid; co-surgeon payment requires supporting documentation, and team surgery is not permitted.
CMS billing rules for 42845
- 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 RVU31.75 · 55%
- Practice expense (office) RVU21.39 · 37%
- Malpractice RVU4.64 · 8%
123
Medicare services in 2024 · #4716 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.
42845 compared with similar codes
Office rates for California, from the same CMS release.
No office rate
42844 is the related radical resection with closure; 42845 distinguishes a closure requiring a free skin graft.
$244.39–$302.13
42808 is for excision of a pharyngeal lesion. This code represents a more extensive radical resection requiring free skin graft closure.
No office rate
42890 describes a limited pharyngectomy. This code is for the specified extensive tonsillar or related oropharyngeal resection with graft closure.
Compare 42845 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 Unavailable | Facility $1958.04 |
| Chico | Office Unavailable | Facility $1944.61 |
| El Centro | Office Unavailable | Facility $1945.38 |
| Fresno | Office Unavailable | Facility $1944.61 |
| Hanford-Corcoran | Office Unavailable | Facility $1944.61 |
| Los Angeles-Long Beach-Anaheim (Los Angeles/Orange Cnty) | Office Unavailable | Facility $2052.05 |
| Madera | Office Unavailable | Facility $1944.61 |
| Merced | Office Unavailable | Facility $1944.61 |
| Modesto | Office Unavailable | Facility $1944.61 |
| Napa | Office Unavailable | Facility $2147.66 |
| Oxnard-Thousand Oaks-Ventura | Office Unavailable | Facility $2031.20 |
| Redding | Office Unavailable | Facility $1944.61 |
| Rest Of California | Office Unavailable | Facility $1944.61 |
| Riverside-San Bernardino-Ontario | Office Unavailable | Facility $1994.80 |
| Sacramento-Roseville-Folsom | Office Unavailable | Facility $2012.63 |
| Salinas | Office Unavailable | Facility $2004.46 |
| San Diego-Chula Vista-Carlsbad | Office Unavailable | Facility $2030.77 |
| San Francisco-Oakland-Berkeley (Marin Cnty) | Office Unavailable | Facility $2239.73 |
| San Francisco-Oakland-Berkeley (San Francisco/San Mateo/Alameda/Contra Costa Cnty) | Office Unavailable | Facility $2234.46 |
| San Jose-Sunnyvale-Santa Clara (San Benito Cnty) | Office Unavailable | Facility $2290.43 |
| San Jose-Sunnyvale-Santa Clara (Santa Clara Cnty) | Office Unavailable | Facility $2268.89 |
| San Luis Obispo-Paso Robles | Office Unavailable | Facility $1975.33 |
| Santa Cruz-Watsonville | Office Unavailable | Facility $2033.87 |
| Santa Maria-Santa Barbara | Office Unavailable | Facility $2006.28 |
| Santa Rosa-Petaluma | Office Unavailable | Facility $2052.70 |
| Stockton | Office Unavailable | Facility $1944.61 |
| Vallejo | Office Unavailable | Facility $2140.06 |
| Visalia | Office Unavailable | Facility $1944.61 |
| Yuba City | Office Unavailable | Facility $1944.61 |
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42845 billing questions
When should this code be selected instead of 42844?
Use 42845 when the radical resection requires closure with a free skin graft. Code 42844 describes the related resection with closure without that graft requirement.
How does this differ from 42842?
Code 42842 is for the related radical resection without closure. This code describes a resection requiring closure with a free skin graft.
Can modifier 50 be reported?
No. Medicare's bilateral adjustment does not apply to this code, and modifier 50 is inappropriate for the descriptor and anatomy.
What postoperative care is included?
The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.
Can an assistant or co-surgeon be paid?
An assistant at surgery may be paid. Co-surgeon payment requires supporting documentation; team surgery is not permitted for this code.
How are other procedures in the same session paid?
The highest-valued procedure is paid in full, and other procedures performed in that session are subject to the standard 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 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.
5,08642836,,Removal of adenoids,A,,3.18,3.03,NA,3.03,,0.46,6.67,6.67,0,090,0.09,0.81,0.10,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,08742842,,Extensive surgery of throat,A,,11.92,13.58,NA,13.58,,1.77,27.27,27.27,0,090,0.09,0.81,0.10,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,08842844,,Extensive surgery of throat,A,,17.34,16.83,NA,16.83,,2.61,36.78,36.78,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,08942845,,Extensive surgery of throat,A,,31.75,21.39,NA,21.39,,4.64,57.78,57.78,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,09042860,,Excision of tonsil tags,A,,2.24,2.80,NA,2.80,,0.34,5.38,5.38,0,090,0.09,0.81,0.10,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,09142870,,Excision of lingual tonsil,A,,5.38,10.25,NA,10.25,,0.79,16.42,16.42,0,090,0.09,0.81,0.10,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,09242890,,Limited pharyngectomy,A,,18.65,16.17,NA,16.17,,2.76,37.58,37.58,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00