No office rate
Both describe radical resection in the tonsillar or retromolar region. Choose 42844 when the defect is closed; 42842 represents resection without closure.
On this page
CMS RVU26D · Effective 2026-10-01
42844 Throat resection Medicare reimbursement rates in Ohio
Reports radical removal of tissue in the tonsillar or retromolar region when the surgical defect is closed as part of the operation. Compare 42844 office and facility rates across CMS payment localities in Ohio.
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 42844 in Ohio?
Ohio 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
No supported rate
Facility setting
$1180.28
1 of 1 localities have a supported rate.
Payment area: Ohio
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 42844: Radical oropharyngeal resection with closure
Reports radical removal of tissue in the tonsillar or retromolar region when the surgical defect is closed as part of the operation.
An otolaryngologist or head and neck surgeon may use this operation to remove extensive disease involving the tonsil, tonsillar pillars, or retromolar trigone, commonly in cancer surgery. The resection includes closure of the resulting defect. The operative report should identify the structures and extent removed and describe how the defect was closed; the closure distinguishes this service from the corresponding radical resection without closure.
Report this code when the documented extent of resection and closure support this level rather than a limited pharyngeal lesion excision or a more extensive flap-closure service. It has a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. 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.
CMS billing rules for 42844
- 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 RVU17.34 · 47%
- Practice expense (office) RVU16.83 · 46%
- Malpractice RVU2.61 · 7%
134
Medicare services in 2024 · #4644 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.
42844 compared with similar codes
Office rates for Ohio, from the same CMS release.
No office rate
This related radical resection code specifies closure using a flap. 42844 represents closure without that flap distinction.
$221.84
42808 is for excision of a pharyngeal lesion, not the radical resection with closure represented by 42844.
No office rate
42890 describes a limited pharyngectomy. 42844 is selected for the specified radical resection of tonsillar, pillar, or retromolar tissue with closure.
Compare 42844 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
Ohio →
Office / nonfacility
Unavailable
Facility
$1180.28
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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 42844 in Ohio.
PPRRVU2026_Oct_nonQPP.csv
5,088
- Code
- 42844
- Physician work
- 17.34
- Practice expense
- 16.83
- Malpractice
- 2.61
GPCI2026.csv
85
- Locality
- Ohio
- Physician work
- 1.000
- Practice expense
- 0.913
- Malpractice
- 1.008
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 17.34 | × 1.000 | 17.3400 |
| Practice expense | 16.83 | × 0.913 | 15.3658 |
| Malpractice | 2.61 | × 1.008 | 2.6309 |
| Total RVUs | 35.3367 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Ohio$1180.28
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 17.34 | 1 |
| Practice expense | 16.83 | 0.913 |
| Malpractice | 2.61 | 1.008 |
(17.34 × 1 + 16.83 × 0.913 + 2.61 × 1.008) × $33.4009 = $1180.28
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.
42844 billing questions
How does 42844 differ from 42842?
42844 includes closure of the defect after the radical resection. 42842 is the corresponding radical resection without closure.
When would 42845 be more appropriate?
Use 42845 when the defect is closed using a flap. 42844 describes closure without that flap distinction.
Can the closure be reported separately?
Closure is part of the service represented by 42844. The operative report should describe it to support choosing this code rather than 42842.
What documentation supports 42844?
Document the structures and extent removed, the radical nature of the resection, and how the surgical defect was closed.
How does the 90-day global affect follow-up billing?
The day-before preoperative visit and 90 days of related postoperative care are included in the global period.
Can an assistant or co-surgeon be reported?
An assistant at surgery may be paid. Co-surgeon payment requires supporting documentation; team surgery is 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.
5,08542835,,Removal of adenoids,A,,2.32,2.82,NA,2.82,,0.35,5.49,5.49,0,090,0.09,0.81,0.10,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,08642836,,Removal of adenoids,A,,3.18,3.03,NA,3.03,,0.46,6.67,6.67,0,090,0.09,0.81,0.10,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,08742842,,Extensive surgery of throat,A,,11.92,13.58,NA,13.58,,1.77,27.27,27.27,0,090,0.09,0.81,0.10,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,08842844,,Extensive surgery of throat,A,,17.34,16.83,NA,16.83,,2.61,36.78,36.78,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,08942845,,Extensive surgery of throat,A,,31.75,21.39,NA,21.39,,4.64,57.78,57.78,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,09042860,,Excision of tonsil tags,A,,2.24,2.80,NA,2.80,,0.34,5.38,5.38,0,090,0.09,0.81,0.10,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,09142870,,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
8213282,NY,99,REST OF NEW YORK,1.000,0.950,0.703
8311502,NC,00,NORTH CAROLINA,1.000,0.933,0.639
8403302,ND,01,NORTH DAKOTA**,1.000,1.000,0.406
8515202,OH,00,OHIO,1.000,0.913,1.008
8604312,OK,00,OKLAHOMA,1.000,0.893,0.777
8702302,OR,01,PORTLAND,1.016,1.111,0.744
8802302,OR,99,REST OF OREGON,1.000,0.996,0.703