$147.31
42809 removes a foreign object from the pharynx. 42800 is for sampling pharyngeal tissue, not extracting an object.
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CMS RVU26D · Effective 2026-10-01
42809 Foreign body removal Medicare reimbursement rates in Kentucky
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 Kentucky.
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 Kentucky?
Kentucky 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
$197.59
1 of 1 localities have a supported rate.
Payment area: Kentucky
One mapped payment locality.
Facility setting
$110.88
1 of 1 localities have a supported rate.
Payment area: Kentucky
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
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 Kentucky, from the same CMS release.
$217.24
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.
$397.23
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.
1 of 1 payment localities
Kentucky →
Office / nonfacility
$197.59
Facility
$110.88
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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 42809 in Kentucky.
PPRRVU2026_Oct_nonQPP.csv
5,075
- Code
- 42809
- Physician work
- 1.81
- Practice expense
- 4.33
- Malpractice
- 0.28
GPCI2026.csv
55
- Locality
- Kentucky
- Physician work
- 1.000
- Practice expense
- 0.889
- Malpractice
- 0.915
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 1.81 | × 1.000 | 1.8100 |
| Practice expense | 4.33 | × 0.889 | 3.8494 |
| Malpractice | 0.28 | × 0.915 | 0.2562 |
| Total RVUs | 5.9156 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Kentucky$197.59
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 1.81 | 1 |
| Practice expense | 4.33 | 0.889 |
| Malpractice | 0.28 | 0.915 |
(1.81 × 1 + 4.33 × 0.889 + 0.28 × 0.915) × $33.4009 = $197.59
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 1.81 | 1 |
| Practice expense | 1.41 | 0.889 |
| Malpractice | 0.28 | 0.915 |
(1.81 × 1 + 1.41 × 0.889 + 0.28 × 0.915) × $33.4009 = $110.88
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.
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
5208102,IN,00,INDIANA,1.000,0.927,0.486
5305102,IA,00,IOWA,1.000,0.915,0.397
5405202,KS,00,KANSAS,1.000,0.904,0.504
5515102,KY,00,KENTUCKY,1.000,0.889,0.915
5607202,LA,01,NEW ORLEANS,1.000,0.941,1.136
5707202,LA,99,REST OF LOUISIANA,1.000,0.885,0.958
5814112,ME,03,SOUTHERN MAINE,1.000,0.991,0.631