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.
On this page
CMS RVU26D · Effective 2026-10-01
42894 Pharyngeal reconstruction Medicare reimbursement rates in Florida
Reports removal of pharyngeal wall tissue when the resulting defect requires reconstruction with a free flap, commonly during head and neck cancer surgery. Compare 42894 office and facility rates across CMS payment localities in Florida.
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 42894 in Florida?
Florida has 3 payment localities in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the 3 payment areas shown below, using the same CMS release.
Office / nonfacility
No supported rate
Facility setting
$2118.36–$2352.76
3 of 3 localities have a supported rate.
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 42894 pays more and less in Florida
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 Florida, from the same CMS release.
No office rate
42890 describes limited pharyngeal resection. Use 42894 when the wall resection requires closure with a free flap.
$233.92–$258.35
42808 is for excision of a pharyngeal lesion; it does not describe the more extensive wall resection and free-flap reconstruction represented by 42894.
Compare 42894 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.
3 of 3 payment localities
Fort Lauderdale →
Office / nonfacility
Unavailable
Facility
$2213.63
Miami →
Office / nonfacility
Unavailable
Facility
$2352.76
Rest Of Florida →
Office / nonfacility
Unavailable
Facility
$2118.36
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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.
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
5,09342892,,Revision of pharyngeal walls,A,,25.38,20.06,NA,20.06,,3.70,49.14,49.14,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,09442894,,Revision of pharyngeal walls,A,,33.07,24.14,NA,24.14,,4.84,62.05,62.05,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,09542900,,Repair throat wound,A,,5.16,2.73,NA,2.73,,0.76,8.65,8.65,0,010,0.10,0.80,0.10,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,0964290F,,Pt scrned for inj drug use,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
5,0974293F,,Pt scrnd hgh-risk sex behav,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