No office rate
Choose 42844 when the extensive resection is followed by closure; this code describes leaving the operative area without closure.
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CMS RVU26D · Effective 2026-10-01
42842 Throat resection Medicare reimbursement rates in Texas
Reports extensive removal of tonsillar or pharyngeal tissue, such as for an oropharyngeal tumor, when the operative defect is left without closure. Compare 42842 office and facility rates across CMS payment localities in Texas.
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 42842 in Texas?
Texas has 8 payment localities in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the 8 payment areas shown below, using the same CMS release.
Office / nonfacility
No 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.
Where 42842 pays more and less in Texas
Otolaryngology surgery
About 42842: Radical oropharyngeal tissue resection without closure
Reports extensive removal of tonsillar or pharyngeal tissue, such as for an oropharyngeal tumor, when the operative defect is left without closure.
An otolaryngologist or head and neck surgeon uses this code for an extensive resection involving the tonsil, tonsillar pillars, and/or pharyngeal walls, commonly to remove an oropharyngeal malignancy. It describes a substantially wider operation than taking a biopsy or removing a discrete, limited pharyngeal lesion. The operative report should identify the structures and extent of tissue removed and state that the resulting area was left without closure.
Report this code when the documented operation matches that extent and closure status; a limited lesion excision or a resection closed primarily or reconstructed points to a different code. Medicare assigns a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. When multiple procedures occur in the same session, the highest-valued is paid in full and other procedures are subject to the standard 50% reduction. Modifier 50 is inappropriate. Assistant-at-surgery payment requires documented medical necessity; co-surgeons and team surgery are not permitted.
CMS billing rules for 42842
- 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 is paid only with documentation of medical necessity.
- Co-surgeons
- Co-surgeons not permitted.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU11.92 · 44%
- Practice expense (office) RVU13.58 · 50%
- Malpractice RVU1.77 · 6%
529
Medicare services in 2024 · #3505 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.
42842 compared with similar codes
Office rates for Texas, from the same CMS release.
No office rate
Choose 42845 when flap reconstruction is performed after the extensive resection. This code is for the resection without closure.
$220.48–$241.78
Code 42808 describes excision of a pharyngeal lesion. This code is for a wider resection involving tonsillar or pharyngeal structures.
No office rate
Code 42890 is for a limited pharyngectomy; this code describes more extensive resection involving the tonsil, tonsillar pillars, and/or pharyngeal walls.
Compare 42842 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.
8 of 8 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Austin | Office Unavailable | Facility $931.21 |
| Beaumont | Office Unavailable | Facility $865.82 |
| Brazoria | Office Unavailable | Facility $896.94 |
| Dallas | Office Unavailable | Facility $904.22 |
| Fort Worth | Office Unavailable | Facility $900.45 |
| Galveston | Office Unavailable | Facility $900.68 |
| Houston | Office Unavailable | Facility $933.08 |
| Rest Of Texas | Office Unavailable | Facility $881.98 |
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42842 billing questions
How does this differ from excision of a pharyngeal lesion?
This code describes extensive removal involving the tonsil, tonsillar pillars, and/or pharyngeal walls. Code 42808 is for excision of a pharyngeal lesion, not this broader resection.
When should a closure or reconstruction code be considered?
Use this code when the operative area is left without closure. If the surgeon closes the defect or reconstructs it with a flap, compare the operation with 42844 or 42845, respectively.
Can modifier 50 be used for resection on both sides?
No. CMS identifies bilateral adjustment as inappropriate for this code; modifier 50 should not be applied.
What documentation supports reporting this code?
Document the tonsillar or pharyngeal structures resected, the extent of the operation, and whether the defect was left without closure. The report should distinguish this extensive resection from a limited lesion excision.
When is an assistant at surgery payable?
CMS payment for an assistant at surgery requires documentation of medical necessity. Co-surgeons and team surgery are not permitted.
How does the 90-day global period affect postoperative billing?
The global period includes the day-before preoperative visit and 90 days of related postoperative care. Those related services are included in the surgical global period.
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.
5,08442831,,Removal of adenoids,A,,2.74,3.23,NA,3.23,,0.40,6.37,6.37,0,090,0.09,0.81,0.10,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,08542835,,Removal of adenoids,A,,2.32,2.82,NA,2.82,,0.35,5.49,5.49,0,090,0.09,0.81,0.10,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,08642836,,Removal of adenoids,A,,3.18,3.03,NA,3.03,,0.46,6.67,6.67,0,090,0.09,0.81,0.10,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,08742842,,Extensive surgery of throat,A,,11.92,13.58,NA,13.58,,1.77,27.27,27.27,0,090,0.09,0.81,0.10,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,08842844,,Extensive surgery of throat,A,,17.34,16.83,NA,16.83,,2.61,36.78,36.78,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,08942845,,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