$221.84–$244.11
42808 describes excision of a pharyngeal lesion. Use 42890 when the surgeon removes a limited portion of the pharynx rather than excising only the lesion.
On this page
CMS RVU26D · Effective 2026-10-01
42890 Pharyngectomy Medicare reimbursement rates in Pennsylvania
Reports surgical removal of a limited portion of the pharynx, such as for a localized lesion requiring resection beyond a simple lesion excision. Compare 42890 office and facility rates across CMS payment localities in Pennsylvania.
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 42890 in Pennsylvania?
Pennsylvania 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
No supported rate
Facility setting
$1205.85–$1306.35
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 42890: Limited pharyngeal resection
Reports surgical removal of a limited portion of the pharynx, such as for a localized lesion requiring resection beyond a simple lesion excision.
An otolaryngologist or head and neck surgeon removes a limited segment of pharyngeal tissue. The operation may treat a localized tumor or another lesion when the surgeon must resect pharyngeal tissue rather than perform a biopsy or remove only a superficial lesion. It is generally performed in an operating room, with the operative report describing the site and extent of tissue removed.
Report this code when the documented procedure is a limited pharyngectomy, not a diagnostic sampling or a more extensive pharyngeal resection. Documentation should identify the pharyngeal site, the tissue removed, and the reason a segmental resection was performed. Medicare 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 procedure is paid in full and other procedures are subject to the standard 50% multiple-procedure reduction. Modifier 50 is inappropriate. Assistant-at-surgery payment may be made; co-surgeon payment requires supporting documentation, and team surgery is not permitted.
CMS billing rules for 42890
- 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 RVU18.65 · 50%
- Practice expense (office) RVU16.17 · 43%
- Malpractice RVU2.76 · 7%
757
Medicare services in 2024 · #3203 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.
42890 compared with similar codes
Office rates for Pennsylvania, from the same CMS release.
No office rate
42892 describes radical or extensive pharyngectomy with resection of part of the esophagus, with or without laryngectomy. 42890 is for a limited pharyngeal resection.
No office rate
42842 is for radical resection involving the tonsil, pillars, and/or soft palate. Select it when that specific operative site and procedure are documented, rather than a limited pharyngeal resection.
Compare 42890 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
Metropolitan Philadelphia →
Office / nonfacility
Unavailable
Facility
$1306.35
Rest Of Pennsylvania →
Office / nonfacility
Unavailable
Facility
$1205.85
Need rates for a whole code list?
Fee-sheet and API access are in early access. Tell us which codes and locations your team needs.
42890 billing questions
How does this differ from excision of a pharyngeal lesion?
Use 42890 when the surgeon removes a limited portion of the pharynx. A localized lesion removed without that degree of pharyngeal resection may be reported with 42808 instead.
When would a more extensive pharyngectomy code be considered?
Consider 42892 when the operative report supports a radical or extensive pharyngectomy involving resection of part of the esophagus, with or without laryngectomy. The documented extent, not the diagnosis alone, distinguishes the procedures.
Is modifier 50 appropriate for bilateral work?
No. CMS identifies bilateral adjustment as inappropriate for this code; do not use modifier 50.
What postoperative care is included?
The 90-day global period includes the day-before preoperative visit and related postoperative care during the 90 days after surgery.
Can an assistant or co-surgeon be reported?
Assistant-at-surgery payment may be made. Co-surgeon payment requires supporting documentation, and team surgery is not permitted.
How are other procedures performed in the same session paid?
The highest-valued procedure is paid in full, and other procedures are subject to the standard 50% multiple-procedure reduction.
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.
5,08942845,,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
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