$206.52
Choose 42700 for drainage of a peritonsillar abscess. Code 42720 describes drainage of a pharyngeal abscess through an intraoral approach.
On this page
CMS RVU26D · Effective 2026-10-01
42720 Pharyngeal abscess drainage Medicare reimbursement rates in Colorado
Reports surgical drainage of a pharyngeal abscess through the mouth, typically when an ENT surgeon accesses a deep throat collection intraorally. Compare 42720 office and facility rates across CMS payment localities in Colorado.
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 42720 in Colorado?
Colorado has 1 payment locality in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the payment area shown below, using the same CMS release.
Office / nonfacility
$455.87
1 of 1 localities have a supported rate.
Payment area: Colorado
One mapped payment locality.
Facility setting
$336.10
1 of 1 localities have a supported rate.
Payment area: Colorado
One mapped payment locality.
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.
Otolaryngology surgery
About 42720: Pharyngeal abscess drainage, intraoral approach
Reports surgical drainage of a pharyngeal abscess through the mouth, typically when an ENT surgeon accesses a deep throat collection intraorally.
An otolaryngologist typically uses this service to open and drain a pharyngeal abscess through the mouth, often in an operating room when a deep throat infection requires surgical drainage. The operative report should identify the pharyngeal collection, document the intraoral route, and describe the incision and drainage performed. This is distinct from drainage of a peritonsillar abscess or drainage of a pharyngeal abscess through an external incision.
Report one service for the abscess drainage and support the code with the location and surgical approach in the operative documentation. Medicare assigns a 10-day global period, so related postoperative visits during that period are included. 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 for this code. Assistant-at-surgery payment requires documentation of medical necessity; co-surgeons and team surgery are not permitted.
CMS billing rules for 42720
- 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
- Assistant at surgery is paid only with documentation of medical necessity.
- Co-surgeons
- Co-surgeons not permitted.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU6.15 · 46%
- Practice expense (office) RVU6.31 · 47%
- Malpractice RVU0.91 · 7%
198
Medicare services in 2024 · #4334 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.
42720 compared with similar codes
Office rates for Colorado, from the same CMS release.
No office rate
Both codes concern pharyngeal abscess drainage; 42720 is the intraoral approach, while 42725 is the external approach.
42999
No office rateUnlisted px phrnx adnd/tnsl
Use 42999 only for a pharyngeal procedure without a specific code. A routine intraoral pharyngeal abscess drainage is described by 42720.
Compare 42720 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.
1 of 1 payment localities
Colorado →
Office / nonfacility
$455.87
Facility
$336.10
Need rates for a whole code list?
Fee-sheet and API access are in early access. Tell us which codes and locations your team needs.
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 42720 in Colorado.
PPRRVU2026_Oct_nonQPP.csv
5,066
- Code
- 42720
- Physician work
- 6.15
- Practice expense
- 6.31
- Malpractice
- 0.91
GPCI2026.csv
37
- Locality
- Colorado
- Physician work
- 1.012
- Practice expense
- 1.064
- Malpractice
- 0.781
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 6.15 | × 1.012 | 6.2238 |
| Practice expense | 6.31 | × 1.064 | 6.7138 |
| Malpractice | 0.91 | × 0.781 | 0.7107 |
| Total RVUs | 13.6484 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Colorado$455.87
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 6.15 | 1.012 |
| Practice expense | 6.31 | 1.064 |
| Malpractice | 0.91 | 0.781 |
(6.15 × 1.012 + 6.31 × 1.064 + 0.91 × 0.781) × $33.4009 = $455.87
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 6.15 | 1.012 |
| Practice expense | 2.94 | 1.064 |
| Malpractice | 0.91 | 0.781 |
(6.15 × 1.012 + 2.94 × 1.064 + 0.91 × 0.781) × $33.4009 = $336.10
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.
42720 billing questions
How is this code distinguished from 42725?
42720 describes intraoral drainage of a pharyngeal abscess. Use 42725 when the surgeon drains the pharyngeal abscess through an external approach.
Is this the code for a peritonsillar abscess?
No. Code 42700 describes drainage of a peritonsillar abscess; 42720 is for a pharyngeal abscess approached through the mouth.
What documentation supports the intraoral approach?
The operative report should identify the pharyngeal abscess and state that the surgeon accessed and drained it intraorally.
Are postoperative visits separately reported during the global period?
Related postoperative visits during the 10-day global period are included in the procedure.
Can an assistant or another surgeon be reported?
Assistant-at-surgery payment requires documentation of medical necessity. Co-surgeons and team surgery are not permitted for this code.
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.
5,06342700,,I&d abscess peritonsillar,A,,1.63,4.07,,1.95,,0.26,5.96,3.84,0,010,0.10,0.80,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,0644270F,,Pt rcvng anti r-viral thxpy,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
5,0654271F,,Pt rcvng anti r-viral thxpy,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
5,06642720,,I&d absc phrngl ntraorl appr,A,,6.15,6.31,,2.94,,0.91,13.37,10.00,0,010,0.10,0.80,0.10,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,06742725,,I&d absc phrngl xtrnl appr,A,,12.10,7.18,NA,7.18,,1.92,21.20,21.20,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,0684274F,,Flu immuno admind rcvd,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
5,0694276F,,Potent antivir thxpy rxd,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
3401112,CA,69,VISALIA,1.017,1.096,0.536
3501112,CA,70,YUBA CITY,1.017,1.096,0.536
3601112,CA,75,REST OF CALIFORNIA,1.017,1.096,0.536
3704112,CO,01,COLORADO,1.012,1.064,0.781
3813102,CT,00,CONNECTICUT,1.020,1.077,1.210
3912202,DC,01,DC + MD/VA SUBURBS,1.054,1.178,1.113
4012102,DE,01,DELAWARE,1.005,0.988,0.899