Billing code 42809: Foreign body removalMedicare rate & RVUs in Texas
Report pharyngeal foreign body removal when a clinician extracts an object lodged in the throat, such as a fish bone, rather than removing tissue.
Medicare pays $200.75–$221.88 for 42809 in the office in Texas, from Beaumont to Austin. Which amount applies depends on the service address.
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 42809 covers
An otolaryngologist commonly removes an object lodged in the pharynx by working through the mouth under direct visualization. A fish bone caught in the tonsillar area or posterior pharynx is a typical example. The procedure may be performed in an office or an operating room, depending on the object’s location, access, and the patient’s ability to tolerate removal. Document the object, its precise pharyngeal location, the approach, and the extraction performed.
Report this code for removal of a foreign object, not for sampling or excising pharyngeal tissue. CMS assigns a 10-day minor-procedure global period, so related postoperative visits during that period are included. When multiple procedures occur 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 not appropriate for this service. CMS does not pay an assistant at surgery for this code, and co-surgeons and team surgery are 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 42809 pays more and less in Texas
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
8 payment localities
$200.75 to $221.88
8 of 8 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Austin | $221.88 | $118.69 |
| Beaumont | $200.75 | $112.00 |
| Brazoria | $211.56 | $114.91 |
| Dallas | $213.07 | $115.93 |
| Fort Worth | $211.75 | $115.58 |
| Galveston | $212.30 | $115.45 |
| Houston | $217.42 | $120.57 |
| Rest Of Texas | $206.15 | $113.59 |
How the 42809 rate is calculated
Each of 42809’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 · 42809
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 1.81Practice expense 4.33Malpractice 0.28
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 42809
42809 has a 10-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 42809
Foreign body removal
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 010 | Minor procedure: the day of the procedure plus 10 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) | 1 | Not paid (statutory restriction). |
| Co-surgeons (62) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
| Split (54/55/56) | 0.10/0.80/0.10 | Share of the payment for pre-op, the procedure itself, and post-op care. |
Global surgery period · 42809
Foreign body removal
10-day global period ends
Oct 11, 2026
Covers Oct 1, 2026 through Oct 11, 2026 (11 days).
Visit on Oct 31, 2026
After the global period ends: visits and procedures are billed normally.
What modifiers do to the payment
Modifier 51 · payment effect
With and without the modifier
42809 without 51 · national office
$214.43
Foreign body removal
42809-51 · Second procedure: 50%
$107.22
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%).
42809 compared with similar codes
Compare codes
42809 vs 42800 vs 42808 vs 31530 vs 43215: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 42800Biopsy
- 42809 removes a foreign object from the pharynx. 42800 is for sampling pharyngeal tissue, not extracting an object.
- 42808Pharyngeal lesion treatment
- Use 42809 for a foreign object; 42808 describes excision of a pharyngeal lesion.
- 31530Laryngoscopy
- Choose 42809 when the object is in the pharynx and 31530 when it is in the larynx and removed by direct operative laryngoscopy.
- 43215Object removal
- Use 42809 for an object lodged in the pharynx. Use 43215 when the object is in the esophagus and removed by flexible esophagoscopy.
42809 billing questions
How is this different from pharyngeal biopsy or lesion excision?
Use 42809 when the target is a foreign object. Use a biopsy or lesion-excision code when the clinician removes tissue for diagnosis or treatment.
Does a fish bone in the throat support this code?
Yes, when the fish bone is lodged in the pharynx and the clinician removes it. Document the specific site and the extraction.
Should modifier 50 be added for objects on both sides?
No. CMS identifies bilateral adjustment as inappropriate for this code; do not report modifier 50.
How does the multiple-procedure reduction affect this service?
When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and the other procedures are subject to the standard 50% reduction.
Are assistant surgeons or co-surgeons payable?
CMS does not pay an assistant at surgery for this code. Co-surgeons and team surgery 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 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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