Billing code 42842: Throat resectionMedicare rate & RVUs in Missouri
Reports extensive removal of tonsillar or pharyngeal tissue, such as for an oropharyngeal tumor, when the operative defect is left without closure.
CMS doesn’t publish an office rate for 42842 in Missouri.
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 42842 covers
An otolaryngologist or head and neck surgeon uses this code for an extensive resection involving the tonsil, tonsillar pillars, and/or pharyngeal walls, commonly to remove an oropharyngeal malignancy. It describes a substantially wider operation than taking a biopsy or removing a discrete, limited pharyngeal lesion. The operative report should identify the structures and extent of tissue removed and state that the resulting area was left without closure.
Report this code when the documented operation matches that extent and closure status; a limited lesion excision or a resection closed primarily or reconstructed points to a different code. Medicare assigns a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. When multiple procedures occur in the same session, the highest-valued is paid in full and other procedures are subject to the standard 50% reduction. Modifier 50 is inappropriate. Assistant-at-surgery payment requires documented medical necessity; co-surgeons and team surgery are 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 42842 pays more and less in Missouri
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
| Payment locality | Office | Facility |
|---|---|---|
| Metropolitan Kansas City | Unavailable | $881.81 |
| Metropolitan St. Louis | Unavailable | $889.19 |
| Rest Of Missouri | Unavailable | $846.71 |
How the 42842 rate is calculated
Each of 42842’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 · 42842
RVUs × geographic indexes × conversion factor
Work11.92
11.92 RVUs× 1.000 GPCI
Practice expense13.58
13.58 RVUs× 1.000 GPCI
Malpractice1.77
1.77 RVUs× 1.000 GPCI
Adjusted RVUs
27.2700
Conversion factor
$33.4009
Medicare rate
$910.84
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 42842
42842 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 42842
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) | 0 | Not paid without supporting documentation. |
| Co-surgeons (62) | 0 | Not permitted. |
| 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 · 42842
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
42842 without 51 · national facility
$910.84
Throat resection
42842-51 · Second procedure: 50%
$455.42
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%).
42842 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 42844Throat resection
- Choose 42844 when the extensive resection is followed by closure; this code describes leaving the operative area without closure.
- 42845Throat resection
- Choose 42845 when flap reconstruction is performed after the extensive resection. This code is for the resection without closure.
- 42808Pharyngeal lesion treatment
- Code 42808 describes excision of a pharyngeal lesion. This code is for a wider resection involving tonsillar or pharyngeal structures.
- 42890Pharyngectomy
- Code 42890 is for a limited pharyngectomy; this code describes more extensive resection involving the tonsil, tonsillar pillars, and/or pharyngeal walls.
42842 billing questions
How does this differ from excision of a pharyngeal lesion?
This code describes extensive removal involving the tonsil, tonsillar pillars, and/or pharyngeal walls. Code 42808 is for excision of a pharyngeal lesion, not this broader resection.
When should a closure or reconstruction code be considered?
Use this code when the operative area is left without closure. If the surgeon closes the defect or reconstructs it with a flap, compare the operation with 42844 or 42845, respectively.
Can modifier 50 be used for resection on both sides?
No. CMS identifies bilateral adjustment as inappropriate for this code; modifier 50 should not be applied.
What documentation supports reporting this code?
Document the tonsillar or pharyngeal structures resected, the extent of the operation, and whether the defect was left without closure. The report should distinguish this extensive resection from a limited lesion excision.
When is an assistant at surgery payable?
CMS payment for an assistant at surgery requires documentation of medical necessity. Co-surgeons and team surgery are not permitted.
How does the 90-day global period affect postoperative billing?
The global period includes the day-before preoperative visit and 90 days of related postoperative care. Those related services are included in the surgical global period.
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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