CPT code 42892: Pharyngeal repair2026 Medicare rate & RVUs in Oregon
Surgical revision of pharyngeal wall anatomy for selected structural deformities, including changes following earlier pharyngeal surgery or injury.
CMS doesn’t publish an office rate for 42892 in Oregon.
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 42892 covers
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.
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 42892 pays more and less in Oregon
| Payment locality | Office | Facility |
|---|---|---|
| Portland | Unavailable | $1,697.62 |
| Rest Of Oregon | Unavailable | $1,601.94 |
How the 42892 rate is calculated
Each of 42892’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 · 42892
RVUs × geographic indexes × conversion factor
Work25.38
25.38 RVUs× 1.000 GPCI
Practice expense20.06
20.06 RVUs× 1.000 GPCI
Malpractice3.70
3.70 RVUs× 1.000 GPCI
Adjusted RVUs
49.1400
Conversion factor
$33.4009
Medicare rate
$1,641.32
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 42892
42892 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 42892
Pharyngeal repair
| 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) | 2 | Paid. |
| Co-surgeons (62) | 1 | Permitted with supporting documentation. |
| 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 · 42892
Pharyngeal repair
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
42892 without 51 · national facility
$1,641.32
Pharyngeal repair
42892-51 · Second procedure: 50%
$820.66
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%).
42892 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 42894Pharyngeal reconstruction
- This is the closest related pharyngeal-wall code. Use the complete code descriptors and operative report to distinguish the specific revision performed.
- 42890Pharyngectomy
- 42890 describes limited removal of pharyngeal tissue; 42892 is for revising pharyngeal wall anatomy.
- 42808Pharyngeal lesion treatment
- 42808 is for excising a pharyngeal lesion. Choose 42892 when the documented procedure revises the wall rather than simply removing a focal lesion.
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 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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