Billing code 42845: Throat resectionMedicare rate & RVUs in Illinois
Reports radical removal of tonsillar or related oropharyngeal tissue when the resulting defect requires closure with a free skin graft.
CMS doesn’t publish an office rate for 42845 in Illinois.
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 42845 covers
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.
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.
Where 42845 pays more and less in Illinois
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
| Payment locality | Office | Facility |
|---|---|---|
| Chicago | Unavailable | $2,141.60 |
| East St. Louis | Unavailable | $2,029.90 |
| Rest Of Illinois | Unavailable | $1,955.00 |
| Suburban Chicago | Unavailable | $2,076.26 |
How the 42845 rate is calculated
Each of 42845’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 · 42845
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 31.75Practice expense 21.39Malpractice 4.64
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 42845
42845 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 42845
Throat resection
| 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 · 42845
Throat resection
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
42845 without 51 · national facility
$1,929.90
Throat resection
42845-51 · Second procedure: 50%
$964.95
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%).
42845 compared with similar codes
Compare codes
42845 vs 42842 vs 42844 vs 42808 vs 42890: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 42842Throat resection
- 42842 describes the related radical resection without closure. Use 42845 when the resection requires closure with a free skin graft.
- 42844Throat resection
- 42844 is the related radical resection with closure; 42845 distinguishes a closure requiring a free skin graft.
- 42808Pharyngeal lesion treatment
- 42808 is for excision of a pharyngeal lesion. This code represents a more extensive radical resection requiring free skin graft closure.
- 42890Pharyngectomy
- 42890 describes a limited pharyngectomy. This code is for the specified extensive tonsillar or related oropharyngeal resection with graft closure.
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 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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