No office rate
This is the closest related pharyngeal-wall code. Use the complete code descriptors and operative report to distinguish the specific revision performed.
On this page
CMS RVU26D · Effective 2026-10-01
42892 Pharyngeal repair Medicare reimbursement rates in Ohio
Surgical revision of pharyngeal wall anatomy for selected structural deformities, including changes following earlier pharyngeal surgery or injury. Compare 42892 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 42892 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
$1584.02
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 42892: Pharyngeal wall revision surgery
Surgical revision of pharyngeal wall anatomy for selected structural deformities, including changes following earlier pharyngeal surgery or injury.
An otolaryngologist or head-and-neck surgeon uses this service to revise pharyngeal wall anatomy, such as a persistent deformity or narrowing after prior pharyngeal surgery or injury. The operation is performed in an operating room, generally in a hospital or ambulatory surgical setting. The operative report should identify the affected pharyngeal segment and describe the wall-revision work performed, rather than only a biopsy or removal of a discrete lesion.
Select the code from the documented operation, not from the symptom alone; record the anatomy, extent of revision, and reason for surgery. CMS assigns 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 is paid in full and others at 50%. Modifier 50 is inappropriate. Assistant-at-surgery payment may be allowed; co-surgeon payment requires supporting documentation, and team surgery is not permitted.
CMS billing rules for 42892
- 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 RVU25.38 · 52%
- Practice expense (office) RVU20.06 · 41%
- Malpractice RVU3.70 · 8%
99
Medicare services in 2024 · #4892 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.
42892 compared with similar codes
Office rates for Ohio, from the same CMS release.
No office rate
42890 describes limited removal of pharyngeal tissue; 42892 is for revising pharyngeal wall anatomy.
$221.84
42808 is for excising a pharyngeal lesion. Choose 42892 when the documented procedure revises the wall rather than simply removing a focal lesion.
Compare 42892 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
$1584.02
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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 42892 in Ohio.
PPRRVU2026_Oct_nonQPP.csv
5,093
- Code
- 42892
- Physician work
- 25.38
- Practice expense
- 20.06
- Malpractice
- 3.70
GPCI2026.csv
85
- Locality
- Ohio
- Physician work
- 1.000
- Practice expense
- 0.913
- Malpractice
- 1.008
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 25.38 | × 1.000 | 25.3800 |
| Practice expense | 20.06 | × 0.913 | 18.3148 |
| Malpractice | 3.70 | × 1.008 | 3.7296 |
| Total RVUs | 47.4244 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Ohio$1584.02
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 25.38 | 1 |
| Practice expense | 20.06 | 0.913 |
| Malpractice | 3.7 | 1.008 |
(25.38 × 1 + 20.06 × 0.913 + 3.7 × 1.008) × $33.4009 = $1584.02
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.
42892 billing questions
How is 42892 distinguished from 42894?
Both concern pharyngeal-wall revision. Compare the operative details with each code's full descriptor and document the specific work performed; the short descriptors alone do not establish which code fits.
When is 42892 preferable to 42808?
42892 describes revision of pharyngeal wall anatomy. Code 42808 is for excision of a pharyngeal lesion, so a focal lesion removal alone does not support 42892.
What should the operative report document?
Identify the pharyngeal segment involved, the structural problem, and the revision performed. Include enough detail to distinguish wall revision from lesion excision or pharyngeal tissue removal.
Can modifier 50 be reported?
No. CMS identifies bilateral adjustment as inappropriate for this code, so modifier 50 should not be used.
How does the 90-day global period affect follow-up billing?
The day-before preoperative visit and 90 days of related postoperative care are included in the global period.
How are other same-session procedures paid?
Under the standard multiple procedure reduction, CMS pays the highest-valued procedure in full and other procedures at 50% when performed in the same session.
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.
5,09042860,,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
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
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