$157.15–$170.36
42800 describes biopsy of a throat lesion for diagnosis. Use 42808 when the service removes or destroys the lesion rather than sampling it alone.
On this page
CMS RVU26D · Effective 2026-10-01
42808 Pharyngeal lesion treatment Medicare reimbursement rates in Oregon
Excision or destruction of a pharyngeal lesion is reported when an otolaryngologist removes or ablates the lesion rather than obtaining a diagnostic sample alone. Compare 42808 office and facility rates across CMS payment localities in Oregon.
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 42808 in Oregon?
Oregon has 2 payment localities in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the 2 payment areas shown below, using the same CMS release.
Office / nonfacility
$230.42–$248.94
2 of 2 localities have a supported rate.
Facility setting
$144.59–$153.20
2 of 2 localities have a supported rate.
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 42808: Pharyngeal lesion excision or destruction
Excision or destruction of a pharyngeal lesion is reported when an otolaryngologist removes or ablates the lesion rather than obtaining a diagnostic sample alone.
An otolaryngologist reports this service for operative removal or destruction of a lesion in the pharynx, such as a mucosal growth on a pharyngeal wall. The procedure may be performed in an operating room or another procedure setting, using the approach suited to the lesion’s location and the surgeon’s method. Tissue may be submitted for pathology when excision produces a specimen; destruction may leave no specimen.
Choose this code when the service treats the lesion by removing or destroying it, not when the service is limited to diagnostic tissue sampling. Document the lesion’s pharyngeal location, the treatment performed, and the extent of removal or destruction; include pathology details when tissue is sent. Related postoperative visits during the 10-day global period are included. 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% multiple-procedure reduction. Modifier 50 is inappropriate for this code. Medicare does not pay an assistant at surgery, and co-surgeon and team-surgery billing are not permitted.
CMS billing rules for 42808
- 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 RVU2.29 · 33%
- Practice expense (office) RVU4.38 · 62%
- Malpractice RVU0.35 · 5%
601
Medicare services in 2024 · #3394 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.
42808 compared with similar codes
Office rates for Oregon, from the same CMS release.
$212.98–$233.14
42804 is for biopsy at a nasopharyngeal site. 42808 describes lesion excision or destruction, not diagnostic sampling.
$237.58–$259.44
42806 is for biopsy at a hypopharyngeal site. Choose 42808 when the service treats the lesion by excision or destruction.
No office rate
42890 describes a limited pharyngectomy, a more extensive pharyngeal resection. 42808 applies to excision or destruction of a lesion.
Compare 42808 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.
2 of 2 payment localities
Portland →
Office / nonfacility
$248.94
Facility
$153.20
Rest Of Oregon →
Office / nonfacility
$230.42
Facility
$144.59
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42808 billing questions
When should this code be used instead of a pharyngeal biopsy code?
Use this code when the lesion is removed or destroyed as treatment. A biopsy code describes diagnostic tissue sampling rather than lesion treatment.
Can pathology be billed separately when tissue is removed?
The surgeon’s lesion treatment and the pathologist’s examination of submitted tissue are distinct services. This code describes the procedure, not the laboratory examination.
Does modifier 50 apply if lesions are treated on both sides?
No. The CMS bilateral adjustment does not apply, and modifier 50 is inappropriate for this code.
How are other procedures in the same session paid?
The highest-valued procedure is paid in full; other procedures in that session are subject to the standard 50% multiple-procedure reduction.
Are assistant surgeons or co-surgeons payable?
Medicare does not pay an assistant at surgery for this code. Co-surgeon and team-surgery billing 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.
5,07142800,,Biopsy of throat,A,,1.40,3.17,,1.57,,0.21,4.78,3.18,0,010,0.10,0.80,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,07242804,,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